Anchor Arthropathy of the Shoulder Joint After Instability Repair: Outcomes Improve With Revision Surgery

摘要

? 2021Purpose: To report clinical and patient-reported outcome measures (PROMs) in patients undergoing revision surgery after diagnosis of anchor-induced arthropathy. Methods: Patients who underwent revision arthroscopic shoulder surgery and were diagnosed with post-instability glenohumeral arthropathy performed from January 2006 to May 2018 were included in the current study. Patients were excluded if they underwent prior open shoulder procedures, if glenoid bone loss was present, or if prerevision imaging and records were incomplete or not available. Data included initial diagnosis and index procedure performed, presenting arthropathy symptoms including duration, exam findings before revision surgery, and surgical intervention. PROMs were prospectively collected before surgery and at minimum 2-year follow-up. Results: Fourteen patients were included with a mean (± standard deviation) age at presentation of 35.2 ± 12.1 years (range 16 to 59). The follow-up rate was 86%, with a mean follow-up of 3.8 years (range 1.1 to 10.6). Mean time to development of arthropathy symptoms was 48.2 months (range <1 month to 13.8 years), all presenting with pain and decreased range of motion on exam. At time of revision surgery, all patients underwent either open or arthroscopic removal of previous implants, including anchors and suture material. Six patients underwent additional revision stabilization procedures, 1 underwent total shoulder arthroplasty, and 7 underwent arthroscopic intraarticular debridement, capsular release, and chondroplasty with or without microfracture. Pain significantly improved in 79% of patients (P =.05). Significant improvements in all PROMs were observed, including 12-item Short Form (43.8 to 54.8, P <.01); Disabilities of the Arm, Shoulder, and Hand, shortened version (31.8 to 8.4, P <.01); Single Assessment Numeric Evaluation (47.0 to 84.5, P <.05); and American Shoulder and Elbow Surgeons (61.6 to 92.1, P <.01). Average external rotation significantly improved, from 31° ± 22° to 52° ± 24° (P =.02). Conclusion: Rapid intervention after diagnosis, through either revision arthroscopic or open debridement and stabilization, can lead to significant improvement in range of motion, pain, and overall patient function and satisfaction. Level of Evidence: IV, retrospective case series.