Background:After arthroscopic Bankart repair (ABR) for anterior glenohumeral instability (GHI), adolescent athletes have higher rates of subsequent recurrent GHI than any other subpopulation. Elucidating which adolescents are at highest risk of postoperative recurrent GHI may optimize surgical decision-making.Purpose:To identify prognostic factors associated with subsequent recurrent GHI requiring revision stabilization surgery (RSS) after ABR.Study Design:Case-control study; Level of evidence, 3.Methods:The study included patients 12 to 21 years old who had undergone ABR for anterior GHI at a pediatric tertiary care hospital by 1 of 5 sports medicine fellowship–trained surgeons between 2000 and 2020. A multivariate Cox proportional hazards model, with percentage of patients with recurrent GHI undergoing subsequent RSS, was used with a time-to-event outcome analysis. The Cox model effects were expressed as the hazard ratio (HR). All tests were 2-sided, with an alpha of .05.Results:Records of 488 adolescent patients with ABR (78% male; mean age, 16.9 ± 1.98 years) were analyzed. Of these, 86 patients (17.6%) underwent subsequent RSS for recurrent GHI, yielding a cumulative risk of 8.8% at 2 years, 16.5% at 5 years, and 20% at 15 years. RSS occurred at a mean of 2.6 ± 2.1 years after ABR. Risk factors for RSS included >1 preoperative dislocation (2 dislocations: HR = 7.4, P = .0003; ≥3 dislocations: HR = 10.9, P < .0001), presence of a Hill-Sachs lesion (small: HR = 2.5, P = .0114; medium-large: HR = 4.2, P = .0004), younger age (1-year decrease: HR = 1.2, P = .0015), and participation in contact sports (HR = 1.8, P = .01). Adolescents with only 1 preoperative dislocation had a cumulative incidence of RSS (3.2%), which was significantly lower than those with 2 (24.2%) or ≥3 preoperative dislocations (33.5%).Conclusion:The number of dislocations before index ABR was the strongest risk factor for recurrent GHI requiring RSS in adolescents with anterior GHI, with 2 dislocations conferring >7-fold increased risk compared with a single preoperative dislocation. Other significant risk factors included the presence of a Hill-Sachs lesion, younger age, and participation in contact sports.

中文翻译：

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关节镜下 Bankart 修复术治疗 2000 年至 2020 年间 488 名青少年盂肱关节前不稳定性：后续复发性不稳定性需要修正稳定的风险因素


背景：在关节镜下 Bankart 修复术 (ABR) 治疗盂肱关节前不稳定 (GHI) 后，青少年运动员随后的 GHI 复发率高于任何其他亚群。阐明哪些青少年术后复发 GHI 的风险最高，可以优化手术决策。目的：确定与 ABR 后需要进行修正稳定手术 (RSS) 的后续复发 GHI 相关的预后因素。证据级别，3。方法：该研究纳入了 2000 年至 2020 年间在儿科三级护理医院接受过 ABR 治疗前部 GHI 的患者，该患者由 5 名经过运动医学专科培训的外科医生中的 1 名进行。多变量 Cox 比例风险该模型包含接受后续 RSS 治疗的复发性 GHI 患者的百分比，用于事件发生时间结果分析。 Cox 模型效应表示为风险比 (HR)。所有测试均为 2 侧测试，α 为 0.05。 结果：分析了 488 名 ABR 青少年患者（78% 男性；平均年龄，16.9 ± 1.98 岁）的记录。其中，86 名患者 (17.6%) 因 GHI 复发而接受了后续 RSS，2 年累积风险为 8.8%，5 年累积风险为 16.5%，15 年累积风险为 20%。 RSS 发生时间平均为 ABR 后 2.6 ± 2.1 年。 RSS 的危险因素包括 >1 个术前脱位（2 个脱位：HR = 7.4，P = .0003；≥3 个脱位：HR = 10.9，P < .0001）、存在 Hill-Sachs 病变（小：HR = 2.5， P = .0114；中-大：HR = 4.2，P = .0004），年龄较小（1 年减少：HR = 1.2，P = .0015），以及参与接触运动（HR = 1.8，P = . 01）。术前仅有 1 次脱位的青少年 RSS 累积发生率 (3.2%)，显着低于 2 次脱位的青少年 (24.1%)。2%) 或 ≥3 个术前脱位 (33.5%)。结论：ABR 之前的脱位数量是前 GHI 青少年复发 GHI 需要 RSS 的最强危险因素，其中 2 个脱位导致风险增加 7 倍以上术前单个脱位。其他重要的危险因素包括存在 Hill-Sachs 病变、年龄较小和参加接触性运动。