Improved Return to Play in Intercollegiate Contact Athletes Following Arthroscopic Stabilization for Anterior Shoulder Instability: A Prospective Multicenter Study

Background: The debate continues regarding the optimal treatment of intercollegiate contact athletes with in-season anterior shoulder instability. Purpose: To examine return to sport and recurrent instability in the season after the index in-season anterior instability event. Study Design: Cohort study; Level of evidence, 2. Methods: Forty-five contact intercollegiate athletes treated nonoperatively or with arthroscopic stabilization were prospectively followed in a multicenter observational study to evaluate return to play (RTP) and recurrent instability in the season after an initial in-season anterior glenohumeral instability event. Baseline data collection included sport played, previous instability events, direction of instability, type of instability (subluxation or dislocation), and treatment method (nonoperative management or arthroscopic stabilization). All nonoperatively treated athletes underwent a standardized accelerated rehabilitation program without shoulder immobilization. Surgical stabilization was performed arthroscopically in all cases, and successful RTP was evaluated during the next competitive season after complete rehabilitation. Results: Thirty-nine of 45 intercollegiate contact athletes had remaining National Collegiate Athletic Association eligibility and were followed through the subsequent competitive season after the index instability event. Of the 10 athletes electing nonoperative treatment, 4 (40%) successfully returned to play without recurrence during the subsequent season. Of the 29 athletes treated surgically, 26 (90%) were able to successfully return to play without recurrence the following season (recurrence: n = 1; inadequate function: n = 2). Athletes who underwent surgical reconstruction before the next season were 5.8 times (95% CI, 1.77-18.97; P = .004) more likely to complete the subsequent season without recurrent instability. Of the 29 athletes electing surgical stabilization, there was no difference (risk ratio, 0.95; 95% CI, 0.10-9.24; P > .99) in RTP between the 9 stabilized after a single instability event (90% RTP rate) and the 20 stabilized after multiple in-season recurrent instability events (89% RTP rate). Conclusion: Collegiate contact and collision athletes with in-season anterior shoulder instability are significantly more likely to successfully return to sport without subsequent instability events the next season if they undergo surgical repair in the off-season.

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Improved Return to Play in Intercollegiate Contact Athletes following Arthroscopic Stabilization for Anterior Shoulder Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967115s00050 ◽

2015 ◽

Vol 3 (7_suppl2) ◽

pp. 2325967115S0005

Author(s):

Jonathan F. Dickens ◽

John Paul H. Rue ◽

Kenneth L. Cameron ◽

Kelly G. Kilcoyne ◽

C. Dain Allred ◽

...

Keyword(s):

Shoulder Instability ◽

Return To Play ◽

Anterior Shoulder Instability ◽

Arthroscopic Stabilization

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The Spectrum of Lesions and Clinical Results of Arthroscopic Stabilization of Acute Anterior Shoulder Instability

Yonsei Medical Journal ◽

10.3349/ymj.2010.51.3.421 ◽

2010 ◽

Vol 51 (3) ◽

pp. 421 ◽

Cited By ~ 13

Author(s):

Doo Sup Kim ◽

Yeo Seung Yoon ◽

Sung Min Kwon

Keyword(s):

Shoulder Instability ◽

Clinical Results ◽

Anterior Shoulder Instability ◽

Arthroscopic Stabilization

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Arthroscopic stabilization of anterior shoulder instability

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1053/jars.2002.36148 ◽

2002 ◽

Vol 18 (8) ◽

pp. 912-924 ◽

Cited By ~ 46

Author(s):

Drew A. Stein ◽

Laith Jazrawi ◽

Arthur R. Bartolozzi

Keyword(s):

Shoulder Instability ◽

Anterior Shoulder Instability ◽

Arthroscopic Stabilization

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A Randomized Clinical Trial Comparing Open and Arthroscopic Stabilization for Recurrent Traumatic Anterior Shoulder Instability

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.l.01656 ◽

2014 ◽

Vol 96 (5) ◽

pp. 353-360 ◽

Cited By ~ 72

Author(s):

Nicholas G.H Mohtadi ◽

Denise S Chan ◽

Robert M Hollinshead ◽

Richard S Boorman ◽

Laurie A Hiemstra ◽

...

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Shoulder Instability ◽

Anterior Shoulder Instability ◽

Arthroscopic Stabilization

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Clinical Outcomes of Patients With Anterior Shoulder Instability and Glenolabral Articular Disruption Lesions: A Retrospective Comparative Study

The American Journal of Sports Medicine ◽

10.1177/0363546520964479 ◽

2020 ◽

Vol 48 (14) ◽

pp. 3472-3477

Author(s):

Martin S. Davey ◽

Eoghan T. Hurley ◽

Christopher A. Colasanti ◽

John P. Scanlon ◽

Mohamed Gaafar ◽

...

Keyword(s):

Clinical Outcomes ◽

Shoulder Instability ◽

Return To Sport ◽

Return To Play ◽

Anterior Shoulder Instability ◽

Control Group ◽

Control Groups ◽

Level Of Evidence ◽

Significant Difference ◽

And Control

Background: Anterior shoulder instability is a common clinical condition that often requires surgical stabilization. Glenoid labral tears are often associated with instability, with glenolabral articular disruption (GLAD) lesions occasionally being identified arthroscopically during repair, particularly in collision athletes. Purpose: To evaluate the clinical outcomes and recurrence rates in patients who had GLAD lesions and underwent arthroscopic Bankart repair (ABR) and compare them with a control group without GLAD lesions. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of patients who underwent ABR with GLAD lesions, by a single surgeon between July 2012 and March 2017, was performed. Additionally, these were pair matched in a 2:1 ratio for age, sex, sport, and level of play with a control group who underwent ABR without GLAD lesions. Return to sport, the level of return, and the timing of return were assessed. The visual analog scale (VAS) for pain score, Rowe score, Shoulder Instability–Return to Sport after Injury (SIRSI) score, and Subjective Shoulder Value (SSV) were evaluated. Results: The study included a total of 66 patients (22 and 44 patients for the GLAD and control groups, respectively), with a mean age of 25.8 years and a mean follow-up of 66 months. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SIRSI, and SSV) utilized for the GLAD and control groups ( P > .05 for all). Similarly, there was no significant difference in the total rate of return to play (90.9% vs 88.6%; P > .99) or return at the same/higher level (68.2% vs 72.7%; P = .78). There was no significant difference in timing of return to play (6.3 ± 6.6 months vs 6.4 ± 2.5 months; P = .98). There were 3 cases (13.6%) requiring further surgery (1 revision stabilization, 1 arthroscopic release, and 1 rotator cuff repair) in the GLAD group and 2 cases (4.5%) requiring further surgery (both revision stabilization) in the control group; the difference was not statistically significant ( P = .32). Conclusion: After arthroscopic repair, patients with GLAD lesions had similar midterm outcomes when compared with a control group without GLAD lesions.

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Return to Play Criteria Following Surgical Stabilization for Traumatic Anterior Shoulder Instability: A Systematic Review

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2017.08.293 ◽

2018 ◽

Vol 34 (3) ◽

pp. 903-913 ◽

Cited By ~ 11

Author(s):

Michael C. Ciccotti ◽

Usman Syed ◽

Ryan Hoffman ◽

Joseph A. Abboud ◽

Michael G. Ciccotti ◽

...

Keyword(s):

Systematic Review ◽

Shoulder Instability ◽

Return To Play ◽

Anterior Shoulder Instability

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Return to Professional Australian Rules Football After Surgery for Traumatic Anterior Shoulder Instability

The American Journal of Sports Medicine ◽

10.1177/03635465211029022 ◽

2021 ◽

pp. 036354652110290

Author(s):

Michael Perret ◽

Sarah Warby ◽

Godefroy Brais ◽

Stephanie Hinse ◽

Sophie Hoy ◽

...

Keyword(s):

Shoulder Instability ◽

Return To Sport ◽

Field Performance ◽

Return To Play ◽

Anterior Shoulder Instability ◽

Level Of Evidence ◽

Australian Football League ◽

Early Return ◽

Significant Difference ◽

Australian Football

Background: The treatment of traumatic anterior shoulder instability in professional Australian Football League (AFL) players is challenging, with an emphasis on early return to play and avoidance of instability recurrence. Purpose: To investigate return-to-sport (RTS) outcomes and complications after 2 different procedures for traumatic anterior shoulder instability in professional AFL players. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed our surgical database for professional AFL players who underwent capsulolabral stabilization or open Latarjet procedure by a single surgeon between 2006 and 2017. Outcomes included RTS, on-field performance, and complications. Between-group analyses for RTS and complications were estimated using Kaplan-Meier survival analyses. Within-group analyses for on-field performance data were performed using paired t tests with significance set at .05. Results: A total of 58 capsulolabral stabilization procedures in 54 players and 32 Latarjet procedures in 29 players were included in the analysis; 93.1% of capsulolabral patients and 96.9% of Latarjet patients returned to professional AFL. The median RTS time was 6.8 months for the capsulolabral group and 7.3 months for the Latarjet group. There was no significant difference in RTS rates between the 2 groups ( P = .270). Of those undergoing surgery early in the season, 75% of the capsulolabral and 71% of Latarjet group were able to RTS within the same season, at a mean time of 16.9 weeks and 18.8 weeks, respectively. There was a significant difference in instability recurrence, with 19% for the capsulolabral group and no recurrence in the Latarjet group ( P = .017). There was no significant reduction in player on-field performance in either group ( P < .05). Conclusion: In this study, the median RTS in AFL players was approximately 7 months after capsulolabral and Latarjet surgery with no compromise to on-field performance. Instability-related complications occurred only in the capsulolabral group, and the incidence increased with time.

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Functional Rehabilitation and Return to Play After Arthroscopic Surgical Stabilization for Anterior Shoulder Instability

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211062852 ◽

2021 ◽

pp. 194173812110628

Author(s):

Timothy D. Kelley ◽

Stephanie Clegg ◽

Paul Rodenhouse ◽

Jon Hinz ◽

Brian D. Busconi

Keyword(s):

Shoulder Instability ◽

Return To Sport ◽

Rehabilitation Program ◽

Return To Play ◽

Bankart Repair ◽

Anterior Shoulder Instability ◽

Functional Rehabilitation ◽

Arthroscopic Bankart Repair ◽

Redislocation Rate

Background: There exists limited objective functional return-to-play criteria after surgical stabilization for anterior shoulder instability in the competitive athlete. Hypothesis: The proposed functional rehabilitation program and psychological evaluation after arthroscopic Bankart repair will help athletes return to sport with a decreased redislocation rate on return. Study Design: Case series. Level of Evidence: Level 4. Methods: Participants were contact or overhead athletes at the high school or collegiate level. Each underwent arthroscopic Bankart repair after a single dislocation event, with less than 10% glenoid bone loss. Western Ontario Shoulder Instability Index (WOSI) scores, Single Assessment Numeric Evaluation (SANE) scores, and American Shoulder and Elbow Surgeons (ASES) scores were evaluated pre- and postoperatively. Athletes were only allowed to return to competition after completing the proposed functional and psychological rehabilitation protocol. Results: A total of 62 participants were enrolled (52 male, 10 female; average age, 18.7 years (range 16-24 years); mean Instability Severity Index Score, 5.63 ± 0.55). All returned to sport for 1 full season and completed a minimum of 2 years of follow-up. The average time to pass functional testing was 6.2 ± 0.7 months, psychological testing was 5.2 ± 0.5 months, and return to sport was 6.5 ± 0.7 months. SANE scores improved from 44.3 to 90.0, ASES from 45.5 to 89.3, and WOSI from 1578.0 to 178.9 (all P < 0.001). Redislocation rate was 6.5% (4 of 62). Conclusion: The proposed functional rehabilitation and psychological assessment protocol is safe and effective in returning athletes to sport after arthroscopic surgical intervention for anterior shoulder instability. This demonstrated a low redislocation rate after 2-year follow-up. Clinical Relevance: Most return-to-play protocols after arthroscopic Bankart repair are centered on recovery time alone, with limited focus on functional rehabilitation, psychological assessment, and return-to-play testing parameters. To our knowledge, this is the first study to propose a dedicated rehabilitation program incorporating functional testing, psychological readiness, and return-to-play criteria for competitive athletes recovering from arthroscopic shoulder stabilization.

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