Clinical Outcomes and Return to Sport After Arthroscopic Anterior, Posterior, and Combined Shoulder Stabilization

Background: Glenohumeral instability is a common abnormality, especially among athletes. Previous studies have evaluated outcomes after arthroscopic stabilization in patients with anterior or posterior shoulder instability but have not compared outcomes between groups. Purpose: To compare return-to-sport and other patient-reported outcomes in patients after primary arthroscopic anterior, posterior, and combined anterior and posterior shoulder stabilization. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary arthroscopic anterior, posterior, or combined anterior and posterior shoulder stabilization were contacted at a minimum 2-year follow-up. Patients completed a survey that consisted of return-to-sport outcomes as well as the Western Ontario Shoulder Instability Index (WOSI), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Sur’geons (ASES) score, and Shoulder Activity Scale. Results: A total of 151 patients were successfully contacted (anterior: n = 81; posterior: n = 22; combined: n = 48) at a mean follow-up of 3.6 years. No significant differences were found between the groups with regard to age at the time of surgery or time to follow-up. No significant differences were found between the groups in terms of WOSI (anterior: 76; posterior: 70; combined: 78; P = .28), SANE (anterior: 87; posterior: 85; combined: 87; P = .79), ASES (anterior: 88; posterior: 83; combined: 91; P = .083), or Shoulder Activity Scale (anterior: 12.0; posterior: 12.5; combined: 12.5; P = .74) scores. No significant difference was found between the groups in terms of the rate of return to sport (anterior: 73%; posterior: 68%; combined: 75%; P = .84). Conclusion: Athletes undergoing arthroscopic stabilization of anterior, posterior, or combined shoulder instability can be expected to share a similar prognosis. High patient-reported outcome scores and moderate to high rates of return to sport were achieved by all groups.

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Outcomes of Arthroscopic Posterior Shoulder Stabilization in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118822452 ◽

2019 ◽

Vol 7 (1) ◽

pp. 232596711882245 ◽

Cited By ~ 3

Author(s):

Ellie A. Moeller ◽

Darby A. Houck ◽

Eric C. McCarty ◽

Adam J. Seidl ◽

Jonathan T. Bravman ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Return To Sport ◽

Patient Reported Outcome ◽

Shoulder Stabilization ◽

Posterior Shoulder ◽

Significant Difference ◽

Patient Reported ◽

Instability Rate

Background: Arthroscopic posterior shoulder stabilization can be performed with patients in the beach-chair (BC) and the lateral decubitus (LD) positions; however, the impact of patient positioning on clinical outcomes has not been evaluated. Purpose: To compare clinical outcomes and recurrence rates after arthroscopic posterior shoulder stabilization performed in the BC and LD positions. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines was performed by searching PubMed, Embase, and the Cochrane Library for studies reporting the clinical outcomes of patients undergoing arthroscopic posterior shoulder stabilization in either the BC or LD position. All English-language studies from 1990 to 2017 reporting clinical outcomes after arthroscopic posterior shoulder stabilization with a minimum 2-year follow-up were reviewed by 2 independent reviewers. Data on the recurrent instability rate, return to activity or sport, range of motion, and patient-reported outcome scores were collected. Study methodological quality was evaluated using the Modified Coleman Methodology Score (MCMS) and Quality Appraisal Tool (QAT). Results: A total of 15 studies (11 LD, 4 BC) with 731 shoulders met the inclusion criteria, including 626 shoulders in the LD position (mean patient age, 23.9 ± 4.1 years; mean follow-up, 37.5 ± 10.0 months) and 105 shoulders in the BC position (mean patient age, 27.8 ± 2.2 years; mean follow-up, 37.9 ± 16.6 months). There was no significant difference in the overall mean recurrent instability rate between the LD and BC groups (4.9% ± 3.6% vs 4.4% ± 5.1%, respectively; P = .83), with similar results in a subanalysis of studies utilizing only suture anchor fixation (4.9% ± 3.6% vs 3.2% ± 5.6%, respectively; P = .54). There was no significant difference in the return-to-sport rate between the BC and LD groups (96.2% ± 5.4% vs 88.6% ± 9.1%, respectively; P = .30). Range of motion and other patient-reported outcome scores were not provided consistently across studies to allow for statistical comparisons. Conclusion: Low rates of recurrent shoulder instability and high rates of return to sport can be achieved after arthroscopic posterior shoulder stabilization in either the LD or the BC position. Additional long-term randomized trials comparing these positions are needed to better understand the potential advantages and disadvantages of surgical positioning for posterior shoulder stabilization.

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Open Capsulorrhaphy for Recurrent Multidirectional Instability of the Shoulder

Video Journal of Sports Medicine ◽

10.1177/26350254211007142 ◽

2021 ◽

Vol 1 (3) ◽

pp. 263502542110071

Author(s):

Ioanna K. Bolia ◽

Rebecca Griffith ◽

Nickolas Fretes ◽

Frank A. Petrigliano

Keyword(s):

Shoulder Instability ◽

Return To Sport ◽

Young Female ◽

Subscapularis Tendon ◽

Shoulder Stabilization ◽

Ehlers Danlos Syndrome ◽

Physically Active ◽

Recurrent Shoulder Instability ◽

Multidirectional Instability

Background: The management of multidirectional instability (MDI) of the shoulder remains challenging, especially in athletes who participate in sports and may require multiple surgical procedures to achieve shoulder stabilization. Open or arthroscopic procedures can be performed to address shoulder MDI. Indications: Open capsulorrhaphy is preferred in patients with underlying tissue hyperlaxity and who had 1 or more, previously failed, arthroscopic shoulder stabilization procedures. Technique Description: With the patient in the beach-chair position (45°), tissue dissection is performed to the level of subscapularis tendon via the deltopectoral approach. The subscapularis tenotomy is performed in an L-shaped fashion, and the subscapularis tendon is tagged with multiple sutures and mobilized. Careful separation of the subscapularis tendon from the underlying capsular tissue is critical. Capsulotomy is performed, consisting of a vertical limb and an inferior limb that extends to the 5 o’clock position on the humeral neck (right shoulder). After evaluating the integrity of the labrum, the capsule is shifted superiorly and laterally, and repaired using 4 to 5 suture anchors. The redundant capsule is excised, and the subscapularis tendon is repaired in a side-to-side fashion, augmented by transosseous equivalent repair using the capsular sutures. Results: Adequate shoulder stabilization was achieved following open capsulorrhaphy in a young female athlete with tissue hyperlaxity and history of a previously failed arthroscopic soft tissue stabilization surgery of the shoulder. The athlete returned to sport at 6 months postoperatively and did not experience recurrent shoulder instability episodes at midterm follow-up. Discussion/Conclusion: Based on the existing literature, 82% to 97% of patients who underwent open capsulorrhaphy for MDI had no recurrent shoulder instability episodes at midterm follow-up. One study reported 64% return-to-sport rate following open capsulorrhaphy in 15 adolescent athletes with Ehlers-Danlos syndrome, but more research is necessary to better define the indications and outcomes of this procedure in physically active patients.

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A Prospective Analysis of Patients With Anterior Versus Posterior Shoulder Instability: A Matched Cohort Examination and Surgical Outcome Analysis of 200 Patients

The American Journal of Sports Medicine ◽

10.1177/0363546518819199 ◽

2019 ◽

Vol 47 (3) ◽

pp. 682-687 ◽

Cited By ~ 7

Author(s):

Andrew S. Bernhardson ◽

Colin P. Murphy ◽

Zachary S. Aman ◽

Robert F. LaPrade ◽

Matthew T. Provencher

Keyword(s):

Shoulder Instability ◽

Matched Cohort ◽

Arthroscopic Stabilization ◽

Mechanism Of Injury ◽

Posterior Shoulder Instability ◽

Anterior Instability ◽

Posterior Instability ◽

Medical Provider ◽

Posterior Shoulder

Background: Anterior and posterior shoulder instabilities are entirely different entities. The presenting complaints and symptoms vastly differ between patients with these 2 conditions, and a clear understanding of these differences can help guide effective treatment. Purpose: To compare a matched cohort of patients with anterior and posterior instability to clearly outline the differences in the initial presenting history and overall outcomes after arthroscopic stabilization. Study Design: Cohort study; Level of evidence, 2. Methods: Consecutive patients with either anterior or posterior glenohumeral instability were prospectively enrolled; patients were excluded if they had more than 10% anterior or posterior glenoid bone loss, multidirectional instability, neurologic injury, or prior surgery. Patients were assigned to anterior or posterior shoulder instability groups based on the history and clinical examination documenting the primary direction of instability, with imaging findings to confirm a labral tear associated with the specific direction of instability. Preoperative demographic data, injury history, and overall clinical outcome scores (American Shoulder and Elbow Surgeons [ASES], Single Assessment Numeric Evaluation [SANE], and Western Ontario Shoulder Index [WOSI]) were assessed and compared statistically between the 2 cohorts. Patients were indicated for surgery if they elected to proceed with surgical management or did not respond to a course of nonoperative management. Results: The study included 103 patients who underwent anterior stabilization (mean age, 23.5 years; range, 18-36 years) and 97 patients who underwent posterior stabilization (mean age, 24.5 years; range, 18-36 years). The mean follow-up was 39.7 months (range, 24-65 months), and there were no age or sex differences between the groups. No patients were lost to follow-up. The primary mechanism of injury in the anterior cohort was a formal dislocation event (82.5% [85/103], of which 46% [39/85] required reduction by a medical provider), followed by shoulder subluxation (12%, 12/103), and “other” (6%, 6/103; no forceful injury). No primary identifiable mechanism of injury was found in the posterior cohort for 78% (75/97) of patients; lifting and pressing (11%, 11/97) and contact injuries (10% [all football blocking], 10/97) were the common mechanisms that initiated symptoms. Only 10 patients (10.3%) in the posterior cohort sustained a dislocation. The most common complaints for patients with anterior instability were joint instability (80%) and pain with activities (32%). In the posterior cohort, the most common complaint was pain (90.7%); only 13.4% in this cohort reported instability as the primary complaint. Clinical outcomes after arthroscopic stabilization were significantly improved in both groups, but the anterior cohort had significantly better outcomes in all scores measured: ASES (preoperative: anterior 58.0, posterior 60.0; postoperative: anterior 94.2 vs posterior 87.7, P < .005), SANE (preoperative: anterior 50.0, posterior 60.0; postoperative: anterior 92.9 vs posterior 84.9, P < .005), and WOSI (preoperative: anterior 55.95, posterior 60.95; postoperative: anterior 92% of normal vs posterior 84%, P < .005). Conclusion: This study outlines clear distinctions between anterior and posterior shoulder instability in terms of presentation and clinical findings. Patients with anterior instability present primarily with an identifiable mechanism of injury and complaints of instability, whereas most patients with classic posterior instability have no identifiable mechanism of injury and their primary symptom is pain. Anterior instability outcomes in this matched cohort were superior in all domains versus posterior instability after arthroscopic stabilization, which further highlights the differences between anterior and posterior instability.

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Return to Sport After Coracoid Transfer in Athletes With Anterior Shoulder Instability: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738119853825 ◽

2019 ◽

Vol 11 (5) ◽

pp. 402-408

Author(s):

Georgina Glogovac ◽

Adam P. Schumaier ◽

Brian M. Grawe

Keyword(s):

Systematic Review ◽

Shoulder Instability ◽

Return To Sport ◽

Patient Reported Outcome ◽

Rate Of Return ◽

Anterior Shoulder Instability ◽

Level Of Evidence ◽

Coracoid Transfer ◽

Patient Reported

Context: Recurrent shoulder instability in young athletes can lead to a spectrum of soft tissue and bony lesions that can be bothersome and/or disabling. Coracoid transfer is a treatment option for athletes with recurrent instability. Objective: To report the rate of return to sport for athletes after coracoid transfer. Data Sources: An electronic search of the literature was performed using the PubMed (MEDLINE) and Cochrane Databases (1966-2018). Study Selection: Studies were included if they evaluated return to sport after treatment with coracoid transfer at a minimum 1-year follow-up. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Data were extracted by 2 authors and included study design, level of evidence, patient demographics (number, age, sex), procedure performed, duration of clinical follow-up, rate of return to sport, patient-reported outcome measures, reoperations, and complications. Results: Fourteen studies met the inclusion criteria. The rate of return to sport at any level ranged from 80% to 100% in all but 1 study (38%), and the rate of return to the previous level of play ranged from 56% to 95% in all but 1 study (16%). Patients returned to sport at an average of 3.2 to 8.1 months. The average patient-reported outcome scores ranged from 78% to 94% (Rowe), 223.6 to 534.3 (Western Ontario Shoulder Instability Index), and 75% to 90% (subjective shoulder value). The rate of postoperative dislocation ranged from 0% to 14%, and the reoperation rate ranged from 1.4% to 13%. Conclusion: There was a high early rate of return to sport in patients who underwent coracoid transfer for anterior shoulder instability, although patients did not reliably return to the same level of play. The procedure had very favorable outcomes for treatment of instability, with low rates of recurrent dislocation and reoperation.

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Clinical Outcomes After Anterior Shoulder Stabilization in Overhead Athletes: An Analysis of the MOON Shoulder Instability Consortium

The American Journal of Sports Medicine ◽

10.1177/0363546519837666 ◽

2019 ◽

Vol 47 (6) ◽

pp. 1404-1410 ◽

Cited By ~ 7

Author(s):

Thai Q. Trinh ◽

Micah B. Naimark ◽

Asheesh Bedi ◽

James E. Carpenter ◽

Christopher B. Robbins ◽

...

Keyword(s):

Clinical Outcomes ◽

Shoulder Instability ◽

Return To Sport ◽

The Moon ◽

Instability Index ◽

Short Term ◽

Shoulder Stabilization ◽

Recurrent Instability ◽

Overhead Athletes

Background: Traumatic anterior shoulder instability is a common condition affecting sports participation among young athletes. Clinical outcomes after surgical management may vary according to patient activity level and sport involvement. Overhead athletes may experience a higher rate of recurrent instability and difficulty returning to sport postoperatively with limited previous literature to guide treatment. Purpose: To report the clinical outcomes of patients undergoing primary arthroscopic anterior shoulder stabilization within the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Consortium and to identify prognostic factors associated with successful return to sport at 2 years postoperatively. Study Design: Case series; Level of evidence, 4. Methods: Overhead athletes undergoing primary arthroscopic anterior shoulder stabilization as part of the MOON Shoulder Instability Consortium were identified for analysis. Primary outcomes included the rate of recurrent instability, defined as any patient reporting recurrent dislocation or reoperation attributed to persistent instability, and return to sport at 2 years postoperatively. Secondary outcomes included the Western Ontario Shoulder Instability Index and Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow questionnaire score. Univariate regression analysis was performed to identify patient and surgical factors predictive of return to sport at short-term follow-up. Results: A total of 49 athletes were identified for inclusion. At 2-year follow-up, 31 (63%) athletes reported returning to sport. Of those returning to sport, 22 athletes (45% of the study population) were able to return to their previous levels of competition (nonrefereed, refereed, or professional) in at least 1 overhead sport. Two patients (4.1%) underwent revision stabilization, although 14 (28.6%) reported subjective apprehension or looseness. Age ( P = .87), sex ( P = .82), and baseline level of competition ( P = .37) were not predictive of return to sport. No difference in range of motion in all planes ( P > .05) and Western Ontario Shoulder Instability Index scores (78.0 vs 80.1, P = .73) was noted between those who reported returning to sport and those who did not. Conclusion: Primary arthroscopic anterior shoulder stabilization in overhead athletes is associated with a low rate of recurrent stabilization surgery. Return to overhead athletics at short-term follow-up is lower than that previously reported for the general athletic population.

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Physiotherapy and Botulinum Toxin Injections Prior to Stabilization Surgery for Recurrent Atraumatic Anteroinferior Shoulder Dislocation with Abnormal Muscle Patterning

Shoulder & Elbow ◽

10.1111/j.1758-5740.2012.00200.x ◽

2012 ◽

Vol 4 (4) ◽

pp. 287-290 ◽

Cited By ~ 2

Author(s):

Clare P. Donnellan ◽

Martin A. Scott ◽

Mary Antoun ◽

W. Angus Wallace

Keyword(s):

Botulinum Toxin ◽

Shoulder Instability ◽

Shoulder Dislocation ◽

Marked Improvement ◽

Latissimus Dorsi ◽

Shoulder Stabilization ◽

Patient Reported ◽

Teres Major ◽

Botulinum Toxin Injections

Shoulder instability is a complex phenomenon and repeated dislocation due to persistent abnormal muscle patterning can be challenging to manage. This case report describes the treatment of a 21-year old female who presented with repeated atraumatic anteroinferior shoulder dislocation due to abnormal muscle patterning. Management involved physiotherapy to re-educate muscle control combined with botulinum toxin injections into pectoralis major, latissimus dorsi and teres major prior to shoulder stabilization surgery. The patient reported marked improvement as reflected by improved scores on the Oxford Shoulder Instability Score and Western Ontario Shoulder Instability Score. Benefits were maintained at 3 year follow-up.

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Superior-Labrum Anterior-Posterior Return to Sport Index (SLAP-RSI) Score to Quantify Psychological Readiness to Return to Play (223)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00331 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0033

Author(s):

Christopher Colasanti ◽

Eoghan Hurley ◽

Nathan Lorentz ◽

Danielle Markus ◽

Bogdan Matache ◽

...

Keyword(s):

Return To Sport ◽

Operative Management ◽

Return To Play ◽

Residual Pain ◽

Superior Labrum ◽

Slap Repair ◽

Number Of Factors ◽

Significant Difference ◽

Anterior Posterior

Objectives: Superior-labrum anterior-posterior (SLAP) tears are common among athletic populations and may require surgical treatment. Return to play post-operatively may be complicated by a number of factors, including psychological readiness to return. The purpose of this study was to evaluate the use of the SLAP Return to Sport Index (SLAP-RSI) score to quantify psychological readiness to return to play following operative management of SLAP tears. Methods: A retrospective review of athletes who underwent operative management of SLAP tears with a minimum of 12-month follow-up was performed. Patients were evaluated for their psychological readiness to return to sport using the SLAP-RSI score. The SLAP-RSI score was created by adapting the terms in the Anterior (ACL-RSI score) with terms related to SLAP tears. A SLAP-RSI score > 56 is considered a passing score for being psychologically ready to return to play. Results: The study included 174 athletes who underwent operative management of SLAP tears. Overall, 73.5% percent of patients were able to return to play, and the mean SLAP-RSI score in this cohort was 74.1±20.9, as compared to 46.7±27.7 in those who were unable to return (p<0.0001). Of those who returned, 82.1% passed the SLAP-RSI benchmark of 56, while of those who did not return, 33.3% passed the SLAP-RSI benchmark of 56. Additionally, a significant difference was found in each component of the SLAP-RSI score between the two cohorts (p<0.05). No individual component of the SLAP-RSI score was below 56 in patients who were able to return to play, while none was above 56 in those who were unable to return. Among patients who were unable to return, ones who cited lifestyle reasons had a higher SLAP-RSI score (77.4 ± 21.8) than those who cited residual pain (28.2 ± 15.1) or fear of re-injury (42.6 ± 23.6) (p<0.0001). Conclusions: Following the operative management of SLAP repair, patients that are unable to return to play exhibit poor psychological readiness to return which may be due to residual pain or fear of re-injury.

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Long Term Outcomes of Anterior Shoulder Instability in Throwers and Overhead Athletes at a Mean Follow-up of 15 years (240)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00348 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0034

Author(s):

Matthew Shirley ◽

Richard Nauert ◽

Ryan Wilbur ◽

Matthew LaPrade ◽

Christopher Bernard ◽

...

Keyword(s):

Shoulder Instability ◽

Treatment Strategies ◽

Return To Sport ◽

Population Based ◽

Return To Play ◽

Anterior Shoulder Instability ◽

Geographic Population ◽

Overhead Athletes ◽

Patient Reported

Objectives: There is a paucity of literature regarding outcomes of anterior shoulder instability (ASI) in throwers and overhead athletes (OHA). The purpose of this study was to report the pathology, treatment strategies, and outcomes of ASI in throwers and overhead athletes utilizing an established US geographic population-based cohort. Methods: An established geographic database of more than 500,000 patients was used to identify athletes <40 years of age with ASI between 1994 and 2016. Medical records were reviewed to obtain demographics, type of sport, surgical details, and clinical outcomes. Patients were contacted after final clinical follow-up for patient reported outcomes (PRO). The Western Ontario Shoulder Instability (WOSI) score, return to sport at previous level of performance (RPP), rate of return to play (RTP) and time to RTP were recorded. Statistical analysis was performed comparing throwers to non-throwers and OHA to non-overhead athletes (NOHA). Results: The study population consisted of 171 patients, 114 NOHA and 57 OHA. Of the OHA, 40 were throwers. The mean follow-up was 14.7 ± 5.6 years for PRO’s and 11.7 ± 7.3 years for last clinical evaluation. No difference in overall instability events was seen in either group. Throwers were more likely to present with subluxations while non-throwers were more likely to present with frank dislocations. NOHA and non-throwers were more likely than OHA and throwers to have a history of trauma related to ASI, respectively ( P = <.001, P = .002). Throwers were more likely to undergo an open surgical procedure (45%) than non-throwers (15%) ( P = .038). The rate of recurrent instability between groups was similar. Throwers returned to sport at a lower rate than non-throwers, however this did not reach significance (64% vs 83%, P = .100). Throwers and OHA reported similar WOSI scores, RPP and time to RTP grouped by surgical or conservative management compared to non-throwers and NOHA, respectively. Conclusions: In a US cohort of patients, throwers and OHA had a similar number of instability events compared to non-throwers and NOHA, respectively. Non-throwers and NOHA were more likely to present with frank dislocation which is supported by the significantly higher rates of trauma in both groups. Notably, the WOSI score, RPP, rate of RTP and time to RTP showed no difference between throwers and OHA when compared to their non-throwing and NOHA counterparts.

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Patients Undergoing Shoulder Stabilization Procedures Do Not Accurately Recall Their Preoperative Symptoms at Short- to Midterm Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119851084 ◽

2019 ◽

Vol 7 (6) ◽

pp. 232596711985108

Author(s):

Danielle Hope ◽

Jacqui French ◽

Tania Pizzari ◽

Greg Hoy ◽

Shane Barwood

Keyword(s):

Shoulder Instability ◽

Intraclass Correlation ◽

Absolute Difference ◽

Minimal Detectable Change ◽

Shoulder Stabilization ◽

Specific Patient ◽

Younger Patients ◽

Significant Difference ◽

Patient Reported ◽

The Mean

Background: A patient’s ability to recall symptoms is poor in some elderly populations, but we considered that the recall of younger patients may be more accurate. The accuracy of recall in younger patients after surgery has not been reported to date. Purpose: To assess younger patients’ abilities to recall their preoperative symptoms after having undergone shoulder stabilization surgery. We used 2 disease-specific, patient-reported outcome measures (PROMs)—the Western Ontario Shoulder Instability Index (WOSI) and the Melbourne Instability Shoulder Score (MISS)—at a period of up to 2 years postoperatively. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Participants (N = 119) were stratified into 2 groups: early recall (at 6-8 months postoperatively; n = 58) and late recall (at 9-24 months postoperatively; n = 61). All patients completed the PROMs with instructions to recall preoperative function. The mean and absolute differences between the preoperative scores and recalled scores for each PROM were compared using paired t tests. Correlations between the actual and recalled scores of the subsections for each PROM were calculated using an intraclass correlation coefficient (ICC). The number of individuals who recalled within the minimal detectable change (MDC) of each PROM was calculated. Results: Comparison between the means of the actual and recalled preoperative scores for both groups did not demonstrate significant differences (early recall differences, MISS 1.05 and WOSI –38.64; late recall differences, MISS –0.25 and WOSI –24.02). Evaluation of the absolute difference, however, revealed a significant difference between actual and recalled scores for both the late and early groups (early recall absolute differences, MISS 12.26 and WOSI 216.71; late recall absolute differences, MISS 12.84 and WOSI 290.08). Average absolute differences were above the MDC scores of both PROMs at both time points. Subsections of each PROM demonstrated weak to moderate correlations between actual and recalled scores (ICC range, 0.17-0.61). Total scores for the PROMs reached moderate agreement between actual and recalled scores. Conclusion: Individual recall after shoulder instability surgery was not accurate. However, the mean recalled PROM scores of each group were not significantly different from the actual scores collected preoperatively, and recall did not deteriorate significantly over 2 years. This suggests that recall of the individual, even in this younger group, cannot be considered accurate for research purposes.

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Recurrent posterior shoulder instability starting in childhood and adolescence

The Bone & Joint Journal ◽

10.1302/0301-620x.102b12.bjj-2020-0296.r1 ◽

2020 ◽

Vol 102-B (12) ◽

pp. 1760-1766

Author(s):

Tristan Langlais ◽

Marie B. Hardy ◽

Vincent Lavoue ◽

Hugo Barret ◽

Adam Wilson ◽

...

Keyword(s):

Return To Sport ◽

Bone Block ◽

Childhood And Adolescence ◽

Posterior Instability ◽

Shoulder Stabilization ◽

Group I ◽

Posterior Shoulder ◽

Age At Surgery ◽

Posterior Bone Block

Aims We aimed to address the question on whether there is a place for shoulder stabilization surgery in patients who had voluntary posterior instability starting in childhood and adolescence, and later becoming involuntary and uncontrollable. Methods Consecutive patients who had an operation for recurrent posterior instability before the age of 18 years were studied retrospectively. All patients had failed conservative treatment for at least six months prior to surgery; and no patients had psychiatric disorders. Two groups were identified and compared: voluntary posterior instability starting in childhood which became uncontrollable and involuntary (group VBI); and involuntary posterior instability (group I). Patients were reviewed and assessed at least two years after surgery by two examiners. Results In all 38 patients (40 shoulders) were included: group I (20 shoulders), with involuntary posterior instability (onset at 14 years of age (SD 2.3), and group VBI (20 shoulders), with initially voluntary posterior instability (onset at 9 years of age (SD 2.6) later becoming involuntary (16 years of age (SD 3.5). Mean age at surgery was 20 years (SD 4.6 years; 12 to 35). A posterior bone block was performed in 18 patients and a posterior capsular shift in 22. The mean follow-up was 7.7 years (2 to 18). Recurrence of posterior instability was seen in nine patients, 30% in group VBI (6/20 shoulders) and 15% in group I (3/20 shoulders) (p > 0.050). At final follow-up, the shoulder's of two patients in each group had been revised. No differences between either group were found for functional outcomes, return to sport, subjective, and radiological results. Conclusion Although achieving stability in patients with so-called voluntary instability, which evolves into an involuntary condition, is difficult, shoulder stabilization may be undertaken with similar outcomes to those patients treated surgically for involuntary instability. Cite this article: Bone Joint J 2020;102-B(12):1760–1766.

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