Arthroscopic Bone Block Stabilization for Anterior Shoulder Instability with Subcritical Glenohumeral Bone Loss.

IF 2.9 2区 医学 Q1 ORTHOPEDICS
Benjamin W Hoyt, Robert T Tisherman, Adam J Popchak, Jonathan F Dickens
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Abstract

Purpose of review: The management options for anterior shoulder instability with minimal bone loss or with critical bone loss are well established. However, there is less clear evidence to guide management for patients with subcritical bone loss, the spectrum of pathology where soft tissue repair alone is prone to higher rates of failures. In this range of bone loss, likely around 13.5% to 20%, the goal of surgery is to restore function and stability while limiting morbidity. As with many procedures in the shoulder, this decision should be tailored to patient anatomy, functional goals, and risk factors. This article provides a review of our current understanding of subcritical bone loss and treatment strategies as well as innovations in management.

Recent findings: While surgeons have largely understood that restoration of anatomy is important to optimize outcomes after stabilization surgery, there is increasing evidence that reconstructing bony anatomy and addressing both osseous and soft tissue structures yields better results than either alone. Even in the setting of subcritical bone loss, there is likely a benefit to combined osseous augmentation with soft tissue management. Additionally, there is new evidence to support management of even on-track humeral lesions when the distance to dislocation is sufficiently small, particularly for athletes. Surgeons must balance bony and soft tissue restoration to achieve optimal outcomes for anterior instability with subcritical bone loss. There are still significant limitations in the literature and several emerging techniques for management will require further study to prove their long-term efficacy. Beyond surgery, there should be a focus on a collaborative treatment strategy with the surgeon, patient, and therapists to achieve high-level function and minimize recurrence.

关节镜骨块稳定术治疗肩关节前方失稳伴亚临界盂肱骨缺失。
审查目的:对于骨质流失量极少或骨质流失量严重的肩关节前部不稳定患者,其治疗方案已得到广泛认可。然而,对于亚临界骨质缺失患者的治疗,目前尚无明确的指导性证据,因为在亚临界骨质缺失的病理范围内,单纯软组织修复的失败率较高。在这一骨丢失范围内(可能在13.5%到20%左右),手术的目标是恢复功能和稳定性,同时限制发病率。与肩部的许多手术一样,这一决定应根据患者的解剖结构、功能目标和风险因素来制定。本文回顾了我们目前对亚临界骨质疏松和治疗策略的理解,以及在管理方面的创新:最近的研究结果:虽然外科医生已基本认识到恢复解剖结构对稳定手术后的最佳疗效非常重要,但越来越多的证据表明,重建骨性解剖结构并同时处理骨性和软组织结构比单独处理任何一种结构都能产生更好的疗效。即使是在亚临界骨质流失的情况下,将骨质增强与软组织处理相结合也可能会带来益处。此外,有新的证据表明,当脱位距离足够小时,即使是赛道上的肱骨病变也能得到治疗,尤其是对运动员而言。外科医生必须平衡骨性和软组织修复,以达到治疗亚临界骨丢失的前方不稳定的最佳效果。目前的文献仍存在很大的局限性,一些新出现的治疗技术还需要进一步的研究来证明其长期疗效。除手术治疗外,还应将重点放在与外科医生、患者和治疗师的合作治疗策略上,以实现高水平的功能并尽量减少复发。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.50
自引率
2.40%
发文量
64
期刊介绍: This journal intends to review the most significant recent developments in the field of musculoskeletal medicine. By providing clear, insightful, balanced contributions by expert world-renowned authors, the journal aims to serve all those involved in the diagnosis, treatment, management, and prevention of musculoskeletal-related conditions. We accomplish this aim by appointing authorities to serve as Section Editors in key subject areas, such as rehabilitation of the knee and hip, sports medicine, trauma, pediatrics, health policy, customization in arthroplasty, and rheumatology. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. We also provide commentaries from well-known figures in the field, and an Editorial Board of more than 20 diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research.
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