Nonoperative Management for In-Season Athletes with Anterior Shoulder Instability

2004 ◽  
Vol 32 (6) ◽  
pp. 1430-1433 ◽  
Author(s):  
Daniel D. Buss ◽  
Gregory P. Lynch ◽  
Christopher P. Meyer ◽  
Shane M. Huber ◽  
Michael Q. Freehill
Keyword(s):  
Shoulder Instability ◽  
Nonoperative Management ◽  
Anterior Shoulder Instability

scholarly journals The Non-Operative Instability Severity Score: A Validated Scoring System to Predict Who Needs Operative Management in the Scholastic Athlete

2018 ◽  
Vol 6 (3_suppl) ◽  
pp. 2325967118S0000
Author(s):  
John M. Tokish ◽  
Charles A. Thigpen ◽  
Michael J. Kissenberth ◽  
Stefan John Tolan ◽  
Keith T. Lonergan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Shoulder Instability ◽  
Scoring System ◽  
Nonoperative Management ◽  
Return To Sport ◽  
Severity Index ◽  
Anterior Shoulder Instability ◽  
Adolescent Athlete ◽  
Risk Of Failure

Objectives: The management of the adolescent athlete who presents for initial treatment after shoulder instability remains controversial. Risk factors such as age, gender, athletic status, and patient goals have all been demonstrated to result in a higher risk of recurrence with nonoperative management, but little work has been done to determine a treatment algorithm that would combine these factors into a decision making algorithm. The purpose of this study, therefore, was to evaluate patients managed nonoperatively for shoulder instability, and to identify factors that led to failure, defined as an inability to return to sport with no subsequent missed time due to shoulder issues. We sought to integrate these factors into a scoring system that would predict the success or failure of nonoperative management in the treatment of shoulder instability in the adolescent athlete. Methods: A retrospective study was conducted of 57 patients who were first time presenters for anterior shoulder instability to a single orthopaedic practice. Inclusion criteria were that patients were managed nonoperatively, that they were involved in high school sports with at least one season of eligibility remaining, and that complete information was available on their ultimate return to their previous sport. Success was defined as those patients who returned to their sport at the same level, and who played at least one subsequent season without any time being missed due to the shoulder that had been unstable. Patient specific risk factors were individually evaluated, and those that were predictive of a higher risk of failure were incorporated into a 10-point Nonoperative Injury Severity Index (NISIS). This score was then retrospectively applied with regression analysis as well as a chi-square analysis to determine the overall score that predicted failure of nonoperative management. Results: Six factors were identified as risk factors and included in the NISIS. Age greater than 15, the presence of bone loss, type of instability (subluxation or dislocation), type of sport (collision vs. non-collision), female gender, and arm dominance, were assigned points based on individual risk. Overall, 79% of patients treated nonoperatively were able to achieve full return to sport without subsequent surgical intervention or missing any time as a result of their shoulder. Patients who had a preoperative NISIS score of >7 returned at over 90% to sport, compared to a success rate of 50% for those who scored <8, revealing an odds ratio of 9.3 times higher risk of failure for those in the high risk group (p=0.001). Conclusion: The non-operative instability severity index is simple and effective preoperative method to determine who is likely to be successful at returning to scholastic sports after presenting for anterior shoulder instability. Further study with a larger prospective cohort should be accomplished to independently validate this score, but this information may be useful for the treating physician to help guide decision making when presented with the unstable shoulder. [Figure: see text]

Return to Sport as an Outcome Measure for Shoulder Instability: Surprising Findings in Nonoperative Management in a High School Athlete Population

2019 ◽  
Vol 47 (5) ◽  
pp. 1062-1067 ◽  
Author(s):  
Ellen Shanley ◽  
Charles Thigpen ◽  
John Brooks ◽  
Richard J. Hawkins ◽  
Amit Momaya ◽  
...  
Keyword(s):  
High School ◽  
Shoulder Instability ◽  
Nonoperative Management ◽  
Return To Sport ◽  
Return To Play ◽  
Anterior Shoulder Instability ◽  
Time Loss ◽  
Additional Time ◽  
High School Athlete ◽  
Treatment Type

Background: Young age and contact sports have been postulated as risk factors for anterior shoulder instability. Management after shoulder instability is controversial, with studies suggesting that nonoperative management increases the risk of recurrence. Several studies examined return to play after an in-season instability episode, and few followed these patients to determine if they were able to successfully compete in a subsequent season. No study has evaluated this question in a high school athlete population. Purpose: To compare the likelihood of return to scholastic sport and complete the next full season without an additional time-loss injury among athletes with anterior shoulder instability in terms of treatment, instability type, and sport classification. Study Design: Cohort study; Level of evidence, 2 Methods: Athletes were included in this study as identified by a scholastic athletic trainer as experiencing a traumatic time-loss anterior shoulder instability injury related to school-sponsored participation. The cohort was predominantly male (n = 108, 84%) and consisted mostly of contact athletes (n = 101, 78%). All athletes had dislocation or subluxation diagnosed by a board-certified physician who determined the athlete’s course of care (nonoperative vs operative). Successful treatment was defined as completion of care and return to the athlete’s index sport, with full participation for the following season. Chi-square and relative risk analyses were completed to compare success of treatment (nonoperative vs operative care) and instability type. Separate logistic regressions were used to compare the effect of sex and sport classification on the athletes’ ability to return to sport. Statistical significance was set a priori as α = .05. Results: Scholastic athletes (N = 129) received nonoperative (n = 97) or operative (n = 32) care. Nonoperatively treated (85%) and operatively treated (72%) athletes successfully returned to the same sport without injury for at least 1 full season ( P = .11). Players sustaining a dislocation were significantly more likely to fail to return when compared with those sustaining a subluxation (26% vs 89%, P = .013). Sex ( P = .85) and sport classification ( P = .74) did not influence the athlete’s ability to return to sport, regardless of treatment type. Conclusion: A high percentage of athletes with shoulder instability achieved successful return to sport without missing any additional time for shoulder injury. Those with subluxations were at almost 3 times the odds of a successful return compared with those sustaining a dislocation.

Successful Return to Sport After Arthroscopic Shoulder Stabilization Versus Nonoperative Management in Contact Athletes With Anterior Shoulder Instability: A Prospective Multicenter Study

2017 ◽  
Vol 45 (11) ◽  
pp. 2540-2546 ◽  
Author(s):  
Jonathan F. Dickens ◽  
John-Paul Rue ◽  
Kenneth L. Cameron ◽  
John M. Tokish ◽  
Karen Y. Peck ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Nonoperative Management ◽  
Return To Sport ◽  
Return To Play ◽  
Surgical Reconstruction ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Stabilization ◽  
Glenohumeral Instability ◽  
Recurrent Instability ◽  
Competitive Season

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.

scholarly journals Comparison between all-suture and biocomposite anchors in the arthroscopic treatment of traumatic anterior shoulder instability: A retrospective cohort study

2021 ◽  
Vol 24 ◽  
pp. 264-270
Author(s):  
Ioannis Pantekidis ◽  
Michael-Alexander Malahias ◽  
Stefania Kokkineli ◽  
Emmanouil Brilakis ◽  
Emmanouil Antonogiannakis
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Shoulder Instability ◽  
Retrospective Cohort ◽  
Arthroscopic Treatment ◽  
Anterior Shoulder Instability

scholarly journals Effectiveness of Latarjet for Anterior Shoulder Instability in Patients with Seizure Disorder

2020 ◽  
Author(s):  
Stephen G. Thonm ◽  
Katherine Branche ◽  
Darby A. Houck ◽  
Tracey Didinger ◽  
Armando F. Vidal ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Seizure Disorder ◽  
Anterior Shoulder Instability

scholarly journals Revision Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Failed Primary Arthroscopic Stabilization With Subcritical Bone Loss

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110018
Author(s):  
Emilio Calvo ◽  
Gonzalo Luengo ◽  
Diana Morcillo ◽  
Antonio M. Foruria ◽  
María Valencia
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Activity Level ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Bankart Repair ◽  
Functional Scores ◽  
Arthroscopic Latarjet

Background: Limited evidence is available regarding the recommended technique of revision surgery for recurrent shoulder instability. Only 1 previous study has compared the results of soft tissue repair and the Latarjet technique in patients with persistent shoulder instability after primary surgical stabilization. Purpose/Hypothesis: To evaluate the results of revision surgery in patients with previous surgical stabilization failure and subcritical glenoid bone defects, comparing repeated Bankart repair versus arthroscopic Latarjet technique. The hypothesis was that Latarjet would be superior to soft tissue procedures in terms of objective and subjective functional scores, recurrence rates, and range of movement. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 45 patients (mean age, 29.1 ± 8.9 years) with subcritical bone loss (<15% of articular surface) who had undergone revision anterior shoulder instability repair after failed Bankart repair. Of these, 17 patients had arthroscopic Bankart repair and 28 had arthroscopic Latarjet surgery. Patients were evaluated at a minimum of 2 years postoperatively with the Rowe score, Western Ontario Shoulder Instability Index, and Subjective Shoulder Value. Subluxation or dislocation episodes were considered failures. Results: No statistically significant differences were found between groups in age, sex, sporting activity, preoperative Rowe score, or the presence of hyperlaxity or bony lesions. At revision arthroscopy, 20 shoulders showed a persistent Bankart lesion, 13 a medially healed labrum, and 6 a bony Bankart. In 6 patients, no abnormalities were present that could explain postoperative recurrence. In the Bankart repair group, 7 patients underwent isolated Bankart procedures; in the remaining 10 cases, a capsular shift was added. No significant differences were found between the Bankart and Latarjet groups in outcome scores, recurrence rate (11.8% vs 17.9%, respectively), or postoperative athletic activity level. The mean loss of passive external rotation at 0° and 90° of abduction was similar between groups. Conclusion: Arthroscopic Latarjet did not lead to superior results compared with repeated Bankart repair in patients with subcritical glenoid bone loss and recurrent anterior shoulder instability after Bankart repair.

Sign in / Sign up

Export Citation Format

Share Document