Rehabilitation Protocol Variability Following Arthroscopic Bankart Repair and Remplissage for Management of Anterior Shoulder Instability: A Systematic Review.
Juan B Villarreal-Espinosa, Michael M Reinold, Mohammad Khak, Mohammad J Shariyate, Carol Mita, Jeffrey Kay, Arun J Ramappa
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引用次数: 0
Abstract
Background: Augmentation of an arthroscopic Bankart repair with the remplissage (ABR) procedure has shown to confer a decrease in recurrence rates, yet, at the expense of potentially compromising shoulder motion.
Purpose/hypothesis: The purpose was to examine clinical studies that described a post-operative rehabilitation protocol after an arthroscopic Bankart repair and remplissage procedure. It was hypothesized that a review of the literature would find variability among the studies and that, among comparative studies, there would be a limited distinction from protocols for isolated Bankart repairs.
Study design: Systematic Review.
Materials and methods: A search was conducted using three databases (PubMed, EMBASE, and CINAHL) according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The following terms were combined while utilizing Boolean operators: (Bankart lesion OR labral tear) AND (remplissage). Studies evaluating patients after arthroscopic stabilization for unidirectional anterior glenohumeral instability with the addition of the remplissage procedure and at least 1 year follow-up were included for analysis.
Results: A total of 41 studies (14 Level IV, 24 Level III, 2 Level II, and 1 Level I) were included with a total of 1,307 patients who underwent ABR. All patients had <30% glenoid bone loss and a range of 10-50% humeral head size Hill-Sachs lesion. Type and position of immobilization were the most reported outcomes (41/41) followed by time of immobilization (40/41). Moreover, 23/41 studies described their initial post-operative shoulder range of motion restrictions, while 17/41 specified any shoulder motion allowed during this restrictive phase. Time to return to sport was also described in 37/41 of the retrieved studies. Finally, only two of the 27 comparative studies tailored their rehabilitation protocol according to the specific procedure performed, underscoring the lack of an individualized approach (i.e. same rehabilitation protocol for different procedures).
Conclusion: The results of the present systematic review expose the variability among rehabilitation protocols following ABR. This variability prompts consideration of the underlying factors influencing these disparities and underscores the need for future research to elucidate optimal rehabilitation. Based on the results of this systematic review and the senior authors´ clinical experience, a rehabilitation approach similar to an isolated Bankart repair appears warranted, with additional precautions being utilized regarding internal rotation range of motion and external rotation strengthening.
背景:在关节镜下进行Bankart修复术后再植术(ABR)可降低复发率,但其代价是可能会影响肩关节的活动:目的/假设:旨在研究描述关节镜下 Bankart 修复和再接合术后康复方案的临床研究。假设文献综述会发现各研究之间存在差异,并且在比较研究中,与孤立的 Bankart 修复术方案之间的差异有限:研究设计:系统综述:根据系统性综述和荟萃分析首选报告项目(PRISMA)指南,使用三个数据库(PubMed、EMBASE 和 CINAHL)进行了检索。在使用布尔运算符时,将以下术语进行了组合:(Bankart病变或唇裂) AND (remplissage)。纳入分析的研究评估了单向盂肱关节前侧不稳定的关节镜稳定术后患者的情况,并增加了remplissage术,且随访至少1年:共纳入 41 项研究(14 项 IV 级研究、24 项 III 级研究、2 项 II 级研究和 1 项 I 级研究),共有 1307 名患者接受了 ABR。所有患者都有结论:本系统综述的结果揭示了 ABR 术后康复方案之间的差异。这种差异促使人们考虑影响这些差异的潜在因素,并强调了未来研究阐明最佳康复方案的必要性。根据本系统综述的结果和资深作者的临床经验,似乎有必要采用类似于孤立Bankart修复术的康复方法,并在内旋活动范围和外旋加强方面采取额外的预防措施:证据等级:3 级。