Accelerated Rehabilitation After Arthroscopic Bankart Repair - A Prospective Randomized Clinical Study -

관절경적 Bankart 봉합술후 적극적 재활치료 - 전향적 임상연구 -

Purpose: In this prospective, randomized study, we compared the results of early motion versus conventional immobilization after the arthroscopic Bankart repair. Materilal and Methods : We performed an arthroscopic Bankart repair using suture anchors in 62 patients with traumatic anterior shoulder instability and randomized them into two groups; Group 1 (n=28; mean age, 28 years) underwent three-week of immobilization and conventional rehabilitation program, while Group 2 (n=34; mean age, 29 years) underwent an accelerated rehabilitation program with staged range of motion and strengthening exercises starting from the immediate postoperative day. Selected patients were non-athletes with a classic Bankart lesion and a robust labrum. Analysis of outcome included pain scores (6-week and follow-up: 31(9 months), range of motion, return to activity, recurrence, patients’ satisfaction with each program, and shoulder scores (ASES, UCLA, and Rowe). Results : The recurrent rate was not different between the two groups (2 anterior apprehension from each group) (p=0.842). Patients with accelerated rehabilitation resumed functional range-of-motion faster and returned earlier to the functional level of activity (p<0.05). Accelerated rehabilitation decreased postoperative pain and more patients were satisfied with this program (p<0.05). No differences were found between the two groups at the follow-up with regards to the shoulder scores, return to activity, pain score, and the range-of-motion. Conclusions : Early mobilization after arthroscopic Bankart repair does not increase the recurrence rate in selected patients. Although the final outcomes are similar in both groups, the accelerated rehabilitation program promotes functional recovery and reduces postoperative pain, which enables patients an early institution of desired activities.

목적 : 관절경적Bankart 봉합술후조기운동과일반적인고정법의임상결과를전향적방법으로비교하고자하였다. 대상및방법 : 외상성재발성전방불안정성이있는62명의환자를대상으로봉합나사를이용하여관절경적 Bankart 봉합술을시행후, 2개의무작위그룹으로분류하였다. 그룹1(28명, 평균나이28세)은3주동안고정한뒤고식적인재활운동을시작하였고그룹2(34명, 평균나이29세)는단계적인관절운동및근력강화운동으로구성된적극적재활운동을수술다음날부터시작하였다. 환자선택의기준은재발성불안정성이있으며전형적인Bankart 병변을가진비운동선수를대상으로하였으며평균31개월동안추시관찰하였다. 결과는통증점수, 관절운동범위, 일상생활로의회복, 재발율, 각재활프로그램에대한환자의만족도그리고shoulder score (ASES, UCLA and Rowe)를분석하였다. 결과 : 두그룹간재발율의차이는없었으며, 어느그룹에서도재발성탈구는나타나지않았다. 각각의그룹에서2명의환자에서전방불안유발검사에서양성소견을나타냈다. 적극적재활치료를한환자는기능적관절운동이더빨랐으며활동의기능적인면에서도더빨리회복되었다. 적극적재활치료를한경우에는술후통증은감소하였고, 재활프로그램에만족하고있으나shoulder scores, 일상생활로의복귀, 통증점수그리고관절운동범위는최종추시시, 두그룹간차이는없었다.결론 : 조기재활은관절경적Bankart 봉합술후선택적환자군에서재발율은증가하지않았다. 두그룹간최종결과는동일하였지만적극적재활운동은기능적회복을촉진하고술후통증을감소시켜일상생활로의빠른복귀가가능하였다.