Background:The use of isolated soft tissue repair versus bone block stabilization for the treatment of recurrent anterior shoulder instability in adolescents has no scientific evidence.Purpose:To compare the clinical outcomes of adolescent patients who underwent isolated arthroscopic Bankart (iB) repair with those who underwent the arthroscopic Bristow-Latarjet procedure in addition to Bankart (BLB) repair.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 60 shoulders in adolescents (aged 13-18 years) were reviewed with a minimum 2 years’ follow-up: iB repair (n = 36) and arthroscopic Bankart repair with an additional Bristow-Latarjet procedure (BLB; n = 24). The characteristics of the patients in each group in terms of age at the first instability episode, age at surgery, hyperlaxity, participation in at-risk sports, and Instability Severity Index Score were comparable. The mean follow-up was longer in the iB group (7.7 vs 4.1 years, respectively), whereas the rates of patients engaged in competition and those with glenoid lesions were higher in the BLB group. The primary outcome measures were failure, defined as the recurrence of instability (clinical dislocation or subluxation), and return to sports. The mean follow-up was 6.2 years (range, 2-16 years).Results:At the last follow-up, the rate of recurrence was significantly higher in the iB group, with 22% (8/36) failures, than in the BLB group, with 8% (2/24) instability recurrences ( P < .05). The rate of return to sports at the same level was significantly higher after the BLB repair than after iB repair (79% vs 47%, respectively; P < .001). No statistical difference was found in patient-reported outcome scores between treatment groups ( P > .05). Although failures occurred early after the BLB repair, 88% of failures after iB repair occurred after 2 years. On multivariate analysis, adolescents in the iB group with >3 episodes of preoperative dislocation and shoulder hyperlaxity (external rotation >90°) had a 60% recurrence rate ( P < .005).Conclusion:Adolescent patients undergoing the BLB repair had a lower rate of recurrent instability and higher rates of return to sports and competition than those undergoing iB repair. Patients with shoulder hyperlaxity (external rotation >90°) and >3 dislocations had an unacceptable failure rate of 60% after iB repair.

中文翻译：

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复发性肩关节前不稳定的青少年在关节镜下 Bristow-Latarjet 手术与关节镜下 Bankart 修复术后恢复运动和比赛的比较

背景：使用孤立性软组织修复与骨块稳定治疗青少年复发性肩关节前不稳定尚无科学证据。目的：比较接受孤立性关节镜 Bankart (iB) 修复术的青少年患者与接受孤立性关节镜 Bankart (iB) 修复术的青少年患者的临床结果除 Bankart (BLB) 修复外，还接受了关节镜 Bristow-Latarjet 手术。 研究设计：队列研究；证据级别，3。方法：对青少年（13-18 岁）总共 60 个肩膀进行了至少 2 年的随访：iB 修复（n = 36）和关节镜 Bankart 修复，并附加 Bristow- Latarjet 程序（BLB；n = 24）。每组患者在首次不稳定发作时的年龄、手术年龄、过度松弛、参与高危运动以及不稳定严重程度指数评分方面的特征具有可比性。 iB 组的平均随访时间较长（分别为 7.7 年和 4.1 年），而 BLB 组的患者参与竞争和关节盂病变的比例较高。主要结果指标是失败（定义为不稳定的复发（临床脱位或半脱位））和恢复运动。平均随访时间为 6.2 年（范围为 2-16 年）。结果：在最后一次随访时，iB 组的复发率显着高于对照组，失败率为 22%（8/36）。 BLB 组的不稳定复发率为 8% (2/24) ( P < .05)。 BLB 修复后恢复相同水平运动的比率显着高于 iB 修复后（分别为 79% 和 47%；P < .001）。治疗组之间患者报告的结果评分没有发现统计学差异 ( P > .05)。虽然故障发生在 BLB 修复后早期，但 iB 修复后 88% 的故障发生在 2 年后。多变量分析显示，iB 组中术前脱位和肩部过度松弛（外旋 >90°）次数超过 3 次的青少年的复发率为 60%（P < .005）。结论：接受 BLB 修复的青少年患者复发率较低与接受 IB 修复的患者相比，复发性不稳定的发生率以及体育和比赛的恢复率更高。肩部过度松弛（外旋 >90°）和脱位 >3 次的患者在 iB 修复后失败率为 60%，令人无法接受。