Factors Associated With Humeral Avulsion of Glenohumeral Ligament Lesions in Patients With Anterior Shoulder Instability: An Analysis of the MOON Shoulder Instability Cohort.
Factors Associated With Humeral Avulsion of Glenohumeral Ligament Lesions in Patients With Anterior Shoulder Instability: An Analysis of the MOON Shoulder Instability Cohort.
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DOI：
10.1177/23259671231206757
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发表时间：
2023-10
影响因子：
2.6
通讯作者：
Lansdown, Drew
中科院分区：
文献类型：
--
作者：
Freshman, Ryan D.;Zhang, Alan L.;Benjamin Ma, C.;Feeley, Brian T.;Ortiz, Shannon;Patel, Jhillika;Dunn, Warren;Wolf, Brian R.;Hettrich, Carolyn;Lansdown, Drew
关键词：
肱骨盂肱韧带撕脱（HAGL）病变是导致盂肱关节前不稳定的一种罕见原因，可能单独发生或与其他病变合并发生。由于HAGL病变很难通过磁共振成像（MRI）和关节镜检查发现，它们可能无法识别并导致持续的盂肱关节不稳定。比较一个大型多中心队列中诊断为和未诊断为HAGL病变的肩关节前不稳定患者，并确定与HAGL病变相关的术前体格检查结果、患者报告结局、影像学结果和手术治疗趋势。横断面研究;证据等级，3。入组了2012年至2020年间在11家骨科中心接受手术治疗的盂肱关节前不稳定患者。将术中发现HAGL病变的患者与无HAGL病变的患者进行比较。收集术前特征、体格检查、影像学表现、术中表现和手术操作。使用Student t检验、Kruskal-Wallis H检验、Fisher精确检验和卡方检验比较各组。在915例（2.3%）患者中共发现21处HAGL病变;约三分之一（28.6%）的病变在术中可见，但在术前MRI上未发现。研究队列之间的基线特征无差异。与非HAGL患者相比，HAGL患者在术前MRI上出现Hill-Sachs病变（54.7% vs 28.6%; P = 0.03）或前盂唇撕裂（87.2% vs 66.7%; P = 0.01）的可能性较小，并且当其受影响的手臂位于外展90°时（85° vs 90°; P = 0.03），外旋增加。此外，HAGL病变与接受开放性稳定手术的风险增加独立相关（比值比，74.6 [95%CI，25.2-221.1]; P <0.001）。大约三分之一的HAGL病变在术前MRI上被遗漏。HAGL患者不太可能表现出与肩关节前不稳定相关的术前影像学结果，如Hill-Sachs病变或前盂唇病变。这些患者接受开放手术的频率高于无HAGL病变的患者。
Humeral avulsion of the glenohumeral ligament (HAGL) lesions are an uncommon cause of anterior glenohumeral instability and may occur in isolation or combination with other pathologies. As HAGL lesions are difficult to detect via magnetic resonance imaging (MRI) and arthroscopy, they can remain unrecognized and result in continued glenohumeral instability. To compare patients with anterior shoulder instability from a large multicenter cohort with and without a diagnosis of a HAGL lesion and identify preoperative physical examination findings, patient-reported outcomes, imaging findings, and surgical management trends associated with HAGL lesions. Cross-sectional study; Level of evidence, 3. Patients with anterior glenohumeral instability who underwent surgical management between 2012 and 2020 at 11 orthopaedic centers were enrolled. Patients with HAGL lesions identified intraoperatively were compared with patients without HAGL lesions. Preoperative characteristics, physical examinations, imaging findings, intraoperative findings, and surgical procedures were collected. The Student t test, Kruskal-Wallis H test, Fisher exact test, and chi-square test were used to compare groups. A total of 21 HAGL lesions were identified in 915 (2.3%) patients; approximately one-third (28.6%) of all lesions were visualized intraoperatively but not identified on preoperative MRI. Baseline characteristics did not differ between study cohorts. Compared with non-HAGL patients, HAGL patients were less likely to have a Hill-Sachs lesion (54.7% vs 28.6%; P = .03) or an anterior labral tear (87.2% vs 66.7%; P = .01) on preoperative MRI and demonstrated increased external rotation when their affected arm was positioned at 90° of abduction (85° vs 90°; P = .03). Additionally, HAGL lesions were independently associated with an increased risk of undergoing an open stabilization surgery (odds ratio, 74.6 [95% CI, 25.2-221.1]; P < .001). Approximately one-third of HAGL lesions were missed on preoperative MRI. HAGL patients were less likely to exhibit preoperative imaging findings associated with anterior shoulder instability, such as Hill-Sachs lesions or anterior labral pathology. These patients underwent open procedures more frequently than patients without HAGL lesions.
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作者：
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