Background:

Excessive general joint laxity, a negative prognostic factor in joint instability, has not been studied to determine its relationship with bipolar bone loss in anterior shoulder instability.

Purpose/Hypothesis:

This study aimed to investigate the characteristics of bipolar bone defects in the presence of excessive joint laxity and the clinical outcomes based on the on-track/off-track theory. We hypothesized that (1) patients with excessive joint laxity might have less significant bipolar bone defects compared with those without excessive joint laxity and (2) no significant difference would be found in the clinical outcomes, including recurrence rate.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study included 81 patients who had undergone arthroscopic Bankart repair, with (group L; n = 33) or without (group N; n = 48) excessive joint laxity. The presence of excessive joint laxity was defined as a score of ≥4 using Beighton and Horan criteria preoperatively. Bipolar bone lesions were assessed using preoperative 3-dimensional computed tomography. Additional remplissage was performed for cases with off-track or positive engagement test in borderline on-track lesions. The functional outcomes at the 2-year follow-up were assessed using the recurrence rate, Subjective Shoulder Value, Rowe score, University of California Los Angeles shoulder score, active range of motion, and the sports/recreation activity level.

Results:

No significant difference was found in the glenoid bone defect between groups (14.1%, group L; 14.4%, group N). Off-track lesions were identified in 39.4% (13/33) of group L and 14.6% (7/48) of group N (P = .011). The mean Hill-Sachs interval to glenoid track ratio was 83.1% in group L and 75.2% in group N (P = .021). Additional remplissage procedures were more frequently performed in group L (48.5%; 16/33) than in group N (16.7%; 8/48) (P = .002). However, no significant difference was observed in the shoulder functional scores and recurrence rates between the groups.

Conclusion:

Patients with anterior shoulder instability and excessive joint laxity had significantly wider Hill-Sachs lesions and more off-track lesions than did those with normal joint laxity despite the lack of a significant difference in the glenoid bone defect. However, these differences in the Hill-Sachs lesion were not related to differences in the functional outcomes between the groups.

中文翻译：

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肩前部不稳中过度关节松弛与更广泛的 Hill-Sachs 病变之间的关联

背景：

过度的全身关节松弛是关节不稳定的负面预后因素，尚未研究确定其与肩关节前部不稳定双极骨丢失的关系。

目的/假设：

本研究旨在探讨关节过度松弛时双极骨缺损的特征以及基于on-track/off-track理论的临床结果。我们假设（1）关节过度松弛的患者与没有过度关节松弛的患者相比，双极骨缺损的显着性可能较低；（2）临床结果（包括复发率）没有显着差异。

学习规划：

队列研究；证据水平，3。

方法：

这项研究包括 81 名接受过关节镜 Bankart 修复的患者，有（L 组；n = 33）或没有（N 组；n = 48）过度关节松弛。存在过度的关节松弛定义为术前使用 Beighton 和 Horan 标准评分≥4。使用术前 3 维计算机断层扫描评估双极骨病变。额外的 remplissage 用于在临界轨道损伤中进行偏离轨道或积极参与测试的病例。使用复发率、主观肩部值、Rowe 评分、加州大学洛杉矶分校肩部评分、主动活动范围和运动/娱乐活动水平评估 2 年随访时的功能结果。

结果：

组间关节盂骨缺损无显着差异（14.1%，L 组；14.4%，N 组）。在 L 组 39.4% (13/33) 和 N 组 14.6% (7/48) 中发现了偏离轨道的病变 ( P = .011)。L 组的平均 Hill-Sachs 间隔与关节盂轨迹的比率为 83.1%，N 组为 75.2%（P = .021）。L 组 (48.5%; 16/33) 比 N 组 (16.7%; 8/48) 更频繁地进行额外的再造手术 ( P = .002)。然而，两组之间的肩部功能评分和复发率没有显着差异。

结论：

尽管关节盂骨缺损没有显着差异，但肩前部不稳定和关节过度松弛的患者与关节松弛正常的患者相比，Hill-Sachs 病变明显更宽且偏离轨道的病变更多。然而，Hill-Sachs 病变的这些差异与组间功能结果的差异无关。