BACKGROUND Arthroscopic capsulolabral reconstruction has proven to be effective in treating posterior shoulder instability. Few studies have examined the risk factors that may contribute to poor outcomes in the adolescent population. PURPOSE To identify risk factors for surgical failure by comparing anatomic and subjective variations in children who underwent surgical intervention for posterior shoulder instability. STUDY DESIGN Case series; Level of evidence, 4. METHODS All patients undergoing arthroscopic shoulder surgery at one institution between 2011 and 2018 were reviewed. Patients >18 years old at presentation and those with Ehlers-Danlos syndrome were excluded. Posterior instability was defined as unidirectional subluxation on posterior drawer testing while under anesthesia. Two-year minimum follow-up was required, but those whose treatment failed earlier were included for calculation purposes. Demographics and intraoperative findings were recorded, as were Single Assessment Numeric Evaluation (SANE) scoring, Pediatric and Adolescent Shoulder Survey (PASS), and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) results. Major complication was defined as revision arthroscopy or redislocation, and minor complications included self-reporting a poor outcome score (eg, SANE score <65). RESULTS A total of 48 children (23 girls and 25 boys) met criteria, with a mean age of 16.5 years (range, 12.4-17.9 years) and a mean follow-up of 3.75 years. Fifteen (31.3%) patients had a complication by our criteria, including 12.5% with surgical failures; regarding major complications, boys were treated successfully 96% of the time and girls 78% of the time (P = .049). Of the anatomic and subjective variables tested, only younger age (P≤ .001) and presentation type (P < .05) were correlated with complications. SANE scores differed significantly (P < .002) by presentation type, with mean scores of 52 (trauma), 94 (recurrent instability), and 81 (pain). QuickDASH scores demonstrated patients with a history of trauma (mean, 37), instability (mean, 9), and pain (mean, 11). CONCLUSION Adolescents treated surgically for posterior shoulder instability are at risk of treatment failure (when including outcome scores), and it appears that patients of female sex, younger age, and traumatic presentation are at the highest risk to require revision surgery or experience continued limitations secondary to their shoulder.

中文翻译：

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后肩不稳：手术结局和青春期失败的风险。

背景技术经关节镜检定的肩cap囊重建术可有效治疗肩部后不稳。很少有研究检查可能导致青春期结局不良的危险因素。目的通过比较因后肩不稳而接受手术干预的儿童的解剖和主观差异来确定手术失败的危险因素。研究设计案例系列；证据级别，第4级。方法回顾了2011年至2018年在一家机构中接受关节镜肩关节手术的所有患者。就诊时年龄> 18岁的患者和患有Ehlers-Danlos综合征的患者被排除在外。后路不稳定性定义为麻醉后路抽屉测试中的单向半脱位。需要至少两年的随访，但是将那些较早治疗失败的患者包括在内以进行计算。记录了人口统计学和术中发现，以及单次评估数字评估（SANE）评分，小儿和青少年肩膀调查（PASS）以及手臂，肩膀和手部残疾（QuickDASH）结果的简短版本。主要并发症定义为关节镜翻修或重新定位，轻微并发症包括自我报告不良预后评分（例如，SANE评分<65）。结果共有48名儿童（23名女孩和25名男孩）符合标准，平均年龄为16.5岁（范围12.4-17.9岁），平均随访时间为3.75岁。根据我们的标准，有15例（31.3％）的患者发生了并发症，其中包括手术失败的12.5％；关于重大并发症，男孩中有96％的时间获得了成功的治疗，女孩中78％的时间得到了成功的治疗（P = .049）。在所测试的解剖和主观变量中，只有年轻（P≤.001）和表现类型（P <.05）与并发症相关。SANE评分因表现类型的不同而有显着差异（P <.002），平均评分为52（创伤），94（复发性不稳定）和81（疼痛）。QuickDASH分数表明患者有外伤史（平均37），不稳定（平均9）和疼痛（平均11）。结论因肩膀后部不稳定而接受手术治疗的青少年处于治疗失败的风险中（包括结局评分），并且女性，年龄较小和外伤表现较高的女性似乎需要进行翻修手术或经历持续的局限性继发风险在他们的肩膀上。