Background:

Patients with posterior shoulder instability may have bone and cartilage lesions (BCLs) in addition to capsulolabral injuries, although the risk factors for these intra-articular lesions are unclear.

Hypothesis:

We hypothesized that patients with posterior instability who had a greater number of instability events would have a higher rate of BCLs compared with patients who had fewer instability episodes.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Data from the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group instability patient cohort were analyzed. Patients aged 12 to 99 years undergoing primary surgical treatment for shoulder instability were included. The glenohumeral joint was evaluated by the treating surgeon at the time of surgery, and patients were classified as having a BCL if they had any grade 3 or 4 glenoid or humeral cartilage lesion, reverse Hill-Sachs lesion, bony Bankart lesion, or glenoid bone loss. The effects of the number of instability events on the presence of BCLs was investigated by use of Fisher exact tests. Logistic regression modeling was performed to investigate the independent contributions of demographic variables and injury-specific variables to the likelihood of having a BCL. Significance was defined as P < .05.

Results:

We identified 271 patients (223 male) for analysis. Bone and cartilage lesions were identified in 54 patients (19.9%) at the time of surgical treatment. A glenoid cartilage injury was most common and was identified in 28 patients (10.3%). A significant difference was noted between the number of instability events and the presence of BCLs (P = .025), with the highest rate observed in patients with 2 to 5 instability events (32.3%). Multivariate logistic regression modeling indicated that increasing age (P = .019) and 2 to 5 reported instability events (P = .001) were significant independent predictors of the presence of BCLs. For bone lesions alone, the number of instability events was the only significant independent predictor; increased risk of bone lesion was present for patients with 1 instability event (OR, 6.1; P = .012), patients with 2 to 5 instability events (OR, 4.2; P = .033), and patients with more than 5 instability events (OR, 6.0; P = .011).

Conclusion:

Bone and cartilage lesions are seen significantly more frequently with increasing patient age and in patients with 2 to 5 instability events. Early surgical stabilization for posterior instability may be considered to potentially limit the extent of associated intra-articular injury. The group of patients with more than 5 instability events may represent a different pathological condition, as this group showed a decrease in the likelihood of cartilage injury, although not bony injury.

中文翻译：

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后路手术治疗的患者关节内骨和软骨病变的危险因素。

背景：

尽管肩关节后囊不稳定，但这些关节内病变的危险因素尚不清楚，但肩关节后部不稳定的患者可能还会出现骨和软骨病变（BCL）。

假设：

我们假设与不稳定事件较少的患者相比，不稳定事件较多的后不稳定患者的BCL发生率更高。

学习规划：

横断面研究；证据水平3。

方法：

分析了来自多中心骨科手术结局网络（MOON）肩组不稳定患者队列的数据。包括因肩关节不稳而接受一次外科手术治疗的12至99岁患者。手术时由主治医生评估肱肱关节，如果患者患有任何3或4级关节盂或肱骨软骨病变，Hill-Sachs反向病变，骨性Bankart病变或关节盂骨，则被分类为BCL失利。通过使用Fisher精确检验研究了不稳定性事件数量对BCL的影响。进行逻辑回归建模以研究人口统计学变量和伤害特定变量对发生BCL可能性的独立贡献。重要性定义为P <.05。

结果：

我们确定了271例患者（223例男性）进行分析。在手术治疗时，有54例（19.9％）的患者发现了骨和软骨病变。关节盂软骨损伤是最常见的，在28例患者中被发现（10.3％）。不稳定事件的数量和BCL的存在之间存在显着差异（P = .025），其中2到5次不稳定事件的患者中观察到的发生率最高（32.3％）。多元logistic回归模型显示年龄增长（P = .019）和2至5个不稳定事件（P= .001）是BCL存在的重要独立预测因子。仅就骨病变而言，失稳事件的数量是唯一重要的独立预测因子。发生1次不稳定事件（OR，6.1; P = .012），发生2至5次不稳定事件（OR，4.2; P = .033）以及发生5次以上不稳定事件的患者的骨病变风险增加（OR，6.0；P = .011）。

结论：

随着患者年龄的增加以及发生2至5次不稳定事件的患者，骨骼和软骨病变的发生率更高。对于后部不稳定，早期手术稳定可能会潜在地限制相关关节内损伤的程度。发生5次以上不稳定事件的患者组可能代表不同的病理状况，因为这组患者虽然不是骨质损伤，但软骨损伤的可能性降低了。