Beach-Chair Versus Lateral Decubitus Positioning for Primary Arthroscopic Anterior Shoulder Stabilization: A Consecutive Series of 641 Shoulders.

Autor:	Yow BG; Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.; John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA.; Department of Orthopaedic Surgery, Eisenhower Army Medical Center, Augusta, Georgia, USA., Anderson AB; Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA., Aburish Z; Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA., Tennent DJ; Department of Orthopaedic Surgery, Evans Army Community Hospital, Fort Carson, Colorado, USA., LeClere LE; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Rue JH; The Orthopaedic Specialty Hospital, Mercy Medical Center, Baltimore, Maryland, USA., Owens BD; Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA., Donohue M; John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA., Cameron KL; John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA., Posner M; Department of Orthopaedic Surgery, WellSpan York Hospital, York, Pennsylvania, USA., Dickens JF; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.; Department of Orthopaedic Surgery, Duke University, Durham, North Carolina.; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Jazyk:	angličtina
Zdroj:	The American journal of sports medicine [Am J Sports Med] 2023 Nov; Vol. 51 (13), pp. 3367-3373. Date of Electronic Publication: 2023 Oct 10.
DOI:	10.1177/03635465231200251
Abstrakt:	Background: There are limited data comparing the beach-chair (BC) versus lateral decubitus (LD) position for arthroscopic anterior shoulder stabilization. Purpose: To identify predictors of instability recurrence and revision after anterior shoulder stabilization and evaluate surgical position and glenoid bone loss as independent predictors of recurrence and revision at short- and midterm follow-ups. Study Design: Cohort study; Level of evidence, 3. Methods: A consecutive series of 641 arthroscopic anterior stabilization procedures were performed from 2005 to 2019. All shoulders were evaluated for glenohumeral bone loss on magnetic resonance imaging. The primary outcomes of interest were recurrence and revision. Multivariable logistic regression models were used to assess the relationships of outcomes with age, position, glenoid bone loss group, and track. Results: A total of 641 shoulders with a mean age of 22.3 years (SD, 4.45 years) underwent stabilization and were followed for a mean of 6 years. The overall 1-year recurrent instability rate was 3.3% (21/641) and the revision rate was 2.8% (18/641). At 1 year, recurrence was observed in 2.3% (11/487) and 6.5% (10/154) of BC and LD shoulders, respectively. The 5-year recurrence and revision rates were 15.7% (60/383) and 12.8% (49/383), respectively. At 5 years, recurrence was observed in 16.4% (48/293) and 13.3% (12/90) of BC and LD shoulders, respectively. Multivariable modeling demonstrated that surgical position was not associated with a risk of recurrence after 1 year (odds ratio [OR] for LD vs BC, 1.39; P = .56) and 5 years (OR for LD vs BC, 1.32; P = .43), although younger age at index surgery was associated with a higher risk of instability recurrence (OR, 1.73 per SD [4.1 years] decrease in age; P < .03). After 1 and 5 years, surgical position results were similar in a separate multivariable logistic regression model of revision surgery as the dependent variable, when adjusted for age, surgical position, bone loss group, and track. At 5 years, younger age was an independent risk factor for revision: OR 1.68 per SD (4.1 years) decrease in age ( P < .05). Conclusion: Among fellowship-trained orthopaedic surgeons, there was no difference in rates of recurrence and revision surgery after performing arthroscopic anterior stabilization in either the BC or the LD position at 1- and 5-year follow-ups. In multivariable analysis, younger age, but not surgical position, was an independent risk factor for recurrence. Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.G.Y. has received support for education from Southtech and Supreme Orthopedic Systems. A.B.A. has received support for education from Supreme Orthopedic Systems. D.J.T. has received support for education from Gemini Mountain Medical and Arthrex. L.E.L. has received support for education from Alpha Orthopedic Systems, Arthrex, and Supreme Orthopedic Systems and a grant from DJO. J.P.R. has received support for education from Supreme Orthopedic Systems and Stryker. B.D.O. has received consulting fees from Linvatec, DePuy Synthes, Vericel, Musculoskeletal Transplant Foundation, and Medical Device Business Services; royalties from Linvatec; and honoraria from Vericel; he is an associate editor for AJSM. M.D. has received support for education from Arthrex, SeaPearl, and Supreme Orthopedic Systems. J.F.D. has received support for education from Supreme Orthopedic Systems and compensation for services other than consulting from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Databáze:	MEDLINE
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