目的：本研究的目的是通过改良的Delphi程序建立关于翻修手术的共识声明，康复并重返赛场，肩关节前不稳定的临床随访。
方法：使用改良的德尔菲技术进行了关于治疗的共识过程，来自5大洲14个国家的65名肩部外科医生参加了会议。专家被分配到9个工作组之一，这些工作组由肩前不稳定中感兴趣的特定子主题定义。
结果：翻修手术的主要相对适应症包括有症状的忧虑或反复发作的不稳定，额外的关节内病变，和症状性硬件故障。在修订案例中，决定治疗的区别因素是肱骨骨丢失的程度和肩袖功能/完整性。允许运动员重返赛场的最短时间是未知的，但是应该考虑其他因素，包括恢复力量，运动范围和本体感受，解决了痛苦和忧虑，因为这些是再损伤的预后因素。此外,康复过程中应考虑心理因素。患者应进行至少12个月的临床随访，或直至完全恢复，病前功能/活动。最后,以下因素应包括在肩前不稳定中，患者报告的结果测量：功能/限制对日常生活活动的影响，回到运动/活动，不稳定症状，对肩膀的信心，和满意度。
结论：总体而言，92%的声明达成一致或强烈共识。达成一致共识的陈述是指征和影响翻修手术决定的因素，以及先前手术如何影响手术选择。此外，心理因素在回归游戏中的作用达成了一致共识，考虑允许重返赛场，以及预后因素。最后,在临床随访的推荐时间和方法上缺乏一致共识.
方法：V级，专家意见。
OBJECTIVE: The purpose of this study was to establish
consensus statements via a modified Delphi process on revision surgery, rehabilitation and return to play, and clinical follow-up for anterior shoulder instability.
METHODS: A
consensus process on the treatment using a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability.
RESULTS: The primary relative indications for revision surgery include symptomatic apprehension or recurrent instability, additional intra-articular pathologies, and symptomatic hardware failure. In revision cases, the differentiating factors that dictate treatment are the degree of glenohumeral bone loss and rotator cuff function/integrity. The minimum amount of time before allowing athletes to return to play is unknown, but other factors should be considered, including restoration of strength, range of motion and proprioception, and resolved pain and apprehension, as these are prognostic factors of reinjury. Additionally, psychological factors should be considered in the rehabilitation process. Patients should be clinically followed up for a minimum of 12 months or until a return to full, premorbid function/activities. Finally, the following factors should be included in anterior shoulder instability-specific, patient-reported outcome measures: function/limitations impact on activities of daily living, return to sport/activity, instability symptoms, confidence in shoulder, and satisfaction.
CONCLUSIONS: Overall, 92% of statements reached unanimous or strong
consensus. The statements that reached unanimous
consensus were indications and factors affecting decisions for revision surgery, as well as how prior surgeries impact procedure choice. Furthermore, there was unanimous
consensus on the role of psychological factors in the return to play, considerations for allowing return to play, as well as prognostic factors. Finally, there was a lack of unanimous consensus on recommended timing and methods for clinical follow-up.
METHODS: Level V, expert opinion.
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