scholarly journals Return to Sport After Arthroscopic Treatment of Posterior Shoulder Instability

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096915
Author(s):  
Attila Pavlik ◽  
Miklós Tátrai ◽  
Eszter Papp
Keyword(s):  
Shoulder Instability ◽  
Sport Activity ◽  
Case Series ◽  
Return To Sport ◽  
Arthroscopic Treatment ◽  
Rate Of Return ◽  
Fisher Exact Test ◽  
Posterior Shoulder Instability ◽  
Posterior Shoulder

Background: Arthroscopic treatment of posterior shoulder instability has become more popular and effective in recent years, but few data are available concerning the rate of return to sport. Purpose: To present our experiences with arthroscopic posterior labral reconstruction in athletes and review our results, with a particular focus on the rate of return to sport. Study Design: Case series; Level of evidence, 4. Methods: Included in the study were 40 arthroscopic stabilizations performed because of posterior shoulder instability in 37 athletes at a single institution. During follow-up, the athletes’ rate of return to sport was calculated. Shoulder function was evaluated based on a pre- versus postoperative comparison of the Rowe instability score and the American Shoulder and Elbow Surgeons score. Additionally, the return-to-sport rate was compared among different subgroups: traumatic versus atraumatic origin of injury, competitive versus recreational athletes, high-risk versus low-risk sport, and posterior-only versus anterior and posterior stabilization. Data were statistically analyzed using paired-samples t test and nonparametric Fisher exact test. Results: The average follow-up period was 54.4 months (range, 24-112 months). Three shoulders (7.5%) continued to have posterior subluxations postoperatively. There were 34 excellent, 3 good, and 3 fair results based on the Rowe score (average postoperative score, 92.9), and patients achieved an average postoperative American Shoulder and Elbow Surgeons score of 92.7. The pre- to postoperative improvement was statistically significant in both scoring systems ( P < .001). Of the 37 patients, 36 (98.2%) were able to return to sport activity: 27 of them (72.9%) to their original sport and 19 (51.4%) at their preinjury level. A significantly higher rate of return to the same sport occurred in athletes who had traumatic injury compared with a subgroup of athletes without a traumatic event ( P < .02). Conclusion: More than half of the athletes were able to return to their preinjury level of sport after arthroscopic posterior labral reconstruction. In addition, low recurrence rates and good functional outcomes were seen in >90% of the patients, and 98% returned to sport activity. The athletes had a significantly higher rate of return to sport if their posterior shoulder instability had a clear traumatic origin.

Arthroscopic Treatment of Posterior Shoulder Instability

2005 ◽  
Vol 33 (10) ◽  
pp. 1463-1471 ◽  
Author(s):  
Matthew T. Provencher ◽  
S. Josh Bell ◽  
Kyle A. Menzel ◽  
Timothy S. Mologne
Keyword(s):  
Shoulder Instability ◽  
Rating Scale ◽  
Effective Means ◽  
Case Series ◽  
Arthroscopic Treatment ◽  
Posterior Shoulder Instability ◽  
Instability Index ◽  
Shoulder Stabilization ◽  
Posterior Shoulder ◽  
Prior Surgery

Background Posterior shoulder instability is a relatively rare condition and a surgical challenge. Arthroscopic techniques have allowed for a potential improvement as well as diagnosis and management of this condition. Purpose To evaluate the outcomes of arthroscopic posterior shoulder stabilization and to evaluate preoperative and intraoperative variables as predictors of success. Study Design Case series; Level of evidence, 4. Methods Thirty-three consecutive patients with a mean age of 25 years (range, 19-34 years) who underwent posterior arthroscopic shoulder stabilization with suture anchors (mean, 3 anchors) or suture capsulolabral plication (mean, 5.3 stitches) or both were reviewed at a mean follow-up of 39.1 months (range, 22-60 months). Shoulder outcomes rating scores were determined using the American Shoulder and Elbow Surgeons Rating Scale, the Western Ontario Shoulder Instability Index, the Subjective Patient Shoulder Evaluation, and the Single Assessment Numeric Evaluation. Results There were 7 failures: 4 for recurrent instability and 3 for symptoms of pain. Overall, outcomes scores demonstrated mean values of the American Shoulder and Elbow Surgeons Rating Scale of 94.6, Subjective Patient Shoulder Evaluation of 20.0, Western Ontario Shoulder Instability Index of 389.4 (81.5% of normal), and Single Assessment Numeric Evaluation of 87.5. Patients with voluntary instability demonstrated worse outcomes (P=. 025), and those with prior surgery of the shoulder also did worse (P=. 02). Conclusion Arthroscopic treatment of posterior shoulder instability is an effective means to improve symptoms associated with recurrent posterior subluxation of the shoulder. It can provide predictable success in the setting of unidirectional, nonvoluntary posterior instability without prior surgery.

scholarly journals Return to Sport After Surgical Management of Posterior Shoulder Instability: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652110111
Author(s):  
Kyle Gouveia ◽  
Jeffrey Kay ◽  
Muzammil Memon ◽  
Nicole Simunovic ◽  
Asheesh Bedi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Management ◽  
Shoulder Instability ◽  
Meta Analysis ◽  
Return To Sport ◽  
High Rate ◽  
Rate Of Return ◽  
Posterior Shoulder Instability ◽  
Rates Of Return ◽  
Posterior Shoulder

Background: Posterior shoulder instability accounts for a small proportion of all shoulder instability, although it can affect athletes of all types, from contact to overhead athletes. Surgical treatment is quite successful in these patients; however, the literature reports a wide range of rates of return to sport. Purpose/Hypothesis: The purpose was to determine the return-to-sport rates after surgical stabilization for posterior shoulder instability. It was hypothesized that patients would experience a high rate of return to sport. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: Embase, PubMed, and MEDLINE were searched for relevant literature from database inception until April 2020, and studies were screened by 2 reviewers independently and in duplicate for studies reporting rates of return to sport after surgical management of posterior shoulder instability. Demographic data as well as data on return to sport and functional outcomes were recorded. A meta-analysis of proportions was used to combine the rates of return to sport using a random effects model. A risk of bias was assessed for all included studies. Results: Overall, 32 studies met inclusion criteria and comprised 1100 patients (1153 shoulders) with a mean age of 22.8 years (range, 11-65) and a mean follow-up of 43.2 months (range, 10-228). The pooled rate of return to any level of sport was 88% (95% CI, 84%-92%; I2 = 68.7%). In addition, the pooled rate of return to the preinjury level was 68% (95% CI, 60%-76%; I2 = 79%). Moreover, the pooled return-to-sport rate for contact athletes was 94% (95% CI, 90%-97%; I2 = 0%), while for throwing athletes it was 88% (95% CI, 83%-92%; I2 = 0%). Conclusion: Surgical management of posterior shoulder instability resulted in a high rate of return to sport, as well as significant pain reduction and functional improvement in most patients. However, only two-thirds of athletes can return to their preinjury levels of sport.

Posterior Shoulder Instability: Surgical Outcomes and Risk of Failure in Adolescence

2020 ◽  
Vol 48 (5) ◽  
pp. 1200-1206
Author(s):  
Alicia M. Asturias ◽  
Tracey P. Bastrom ◽  
Andrew T. Pennock ◽  
Eric W. Edmonds
Keyword(s):  
Risk Factors ◽  
Shoulder Instability ◽  
Case Series ◽  
Short Version ◽  
Posterior Shoulder Instability ◽  
Level Of Evidence ◽  
Ehlers Danlos Syndrome ◽  
Posterior Shoulder ◽  
Younger Age

Background: Arthroscopic capsulolabral reconstruction has proven to be effective in treating posterior shoulder instability. Few studies have examined the risk factors that may contribute to poor outcomes in the adolescent population. Purpose: To identify risk factors for surgical failure by comparing anatomic and subjective variations in children who underwent surgical intervention for posterior shoulder instability. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing arthroscopic shoulder surgery at one institution between 2011 and 2018 were reviewed. Patients >18 years old at presentation and those with Ehlers-Danlos syndrome were excluded. Posterior instability was defined as unidirectional subluxation on posterior drawer testing while under anesthesia. Two-year minimum follow-up was required, but those whose treatment failed earlier were included for calculation purposes. Demographics and intraoperative findings were recorded, as were Single Assessment Numeric Evaluation (SANE) scoring, Pediatric and Adolescent Shoulder Survey (PASS), and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) results. Major complication was defined as revision arthroscopy or redislocation, and minor complications included self-reporting a poor outcome score (eg, SANE score <65). Results: A total of 48 children (23 girls and 25 boys) met criteria, with a mean age of 16.5 years (range, 12.4-17.9 years) and a mean follow-up of 3.75 years. Fifteen (31.3%) patients had a complication by our criteria, including 12.5% with surgical failures; regarding major complications, boys were treated successfully 96% of the time and girls 78% of the time ( P = .049). Of the anatomic and subjective variables tested, only younger age ( P≤ .001) and presentation type ( P < .05) were correlated with complications. SANE scores differed significantly ( P < .002) by presentation type, with mean scores of 52 (trauma), 94 (recurrent instability), and 81 (pain). QuickDASH scores demonstrated patients with a history of trauma (mean, 37), instability (mean, 9), and pain (mean, 11). Conclusion: Adolescents treated surgically for posterior shoulder instability are at risk of treatment failure (when including outcome scores), and it appears that patients of female sex, younger age, and traumatic presentation are at the highest risk to require revision surgery or experience continued limitations secondary to their shoulder.

scholarly journals Outcomes After Arthroscopic Anterior Shoulder Stabilization in Professional Handball Players

2021 ◽  
Vol 9 (7) ◽  
pp. 232596712110116
Author(s):  
Attila Pavlik ◽  
Miklós Tátrai ◽  
Annamária Tátrai ◽  
András Tállay
Keyword(s):  
Shoulder Instability ◽  
Case Series ◽  
High Risk Group ◽  
Arthroscopic Treatment ◽  
Anterior Shoulder Instability ◽  
Fisher Exact Test ◽  
Level Of Evidence ◽  
Study Results ◽  
The Mean

Background: Although numerous studies have reported on the redislocation rate and functional results of arthroscopic treatment for anterior shoulder instability in athletes, they have not disclosed outcomes in the high-risk group of elite handball players. Purpose: To investigate the postoperative outcomes of arthroscopic treatment for anterior shoulder instability as well as the return-to-sport (RTS) rate in professional handball players. Study Design: Case series; Level of evidence, 4. Methods: Involved in this study were 44 competitive handball players (47 shoulders) who underwent arthroscopic anterior capsulolabral reconstruction between 2010 and 2018 and had a minimum follow-up of 24 months. After surgery, patients completed a questionnaire that collected Rowe and American Shoulder and Elbow Surgeons (ASES) scores and RTS data, and we compared these results with their preoperative scores. We also compared results according to the following subgroups: true dislocations versus recurrent subluxations, younger (<20 years) versus older (≥20 years) age, male versus female sex, and shorter versus longer duration of instability. Statistical analysis included the paired-samples t test and nonparametric Fisher exact test. Results: The mean follow-up period was 52.2 ± 21.4 months. There were 4 shoulders (9%) with recurrent instability. There were significant preoperative to postoperative improvements in the mean Rowe score (from 45.2 to 91.8) and mean ASES score (from 70.6 to 95.7) ( P < .001 for both). Overall, the RTS rate was 83%, and 64% (30/47 shoulders) were able to return to their preinjury level. The RTS rate was significantly lower in the younger players than in the older players (46% vs 86%, respectively; P = .005). Conclusion: The study results indicated that handball players with anterior shoulder instability can be treated using arthroscopic labral reconstruction successfully and 83% of the athletes were able to RTS activity. The handball players aged ≥20 years returned to their preinjury level of sport at a higher rate than did those aged <20 years.

scholarly journals Non-operative Management of Posterior Shoulder Instability: An Assessment of Survival and Predictors for Conversion to Surgery at 1 to 13 Years After Diagnosis

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0009
Author(s):  
Jarret Murray Woodmass ◽  
Julia Lee ◽  
Nick R. Johnson ◽  
Christopher L. Camp ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Radiographic Progression ◽  
Surgical Intervention ◽  
Cox Proportional Hazards ◽  
Posterior Shoulder Instability ◽  
Late Failure ◽  
Posterior Shoulder ◽  
Increased Risk ◽  
History Of

Objectives: Among patients treated non-operatively for 1 year following a diagnosis of posterior shoulder instability (PSI), little is known about the the incidence of surgery between 1-13 years after injury. The purpose of this study is to define the frequency and evaluate the factors predictive for late surgical intervention of symptomatic PSI. Methods: This study included a population-based cohort of 115 patients (14 females, 101 males) diagnosed with PSI between January 1994 and July 2012 with a minimum 5-years follow-up (mean:13.9 years; range: 5-23 years). Landmark survival analysis was performed to evaluate incidence of surgery after 1 year. Survival was estimated using Kaplan Meier method and predictors of late surgical intervention were analyzed using Cox proportional hazards regression. Results: A total of 61/115 (53%) patients were treated non-operatively for 1 year following diagnosis of PSI. Of these, 24/61 (39%) converted to surgery for symptomatic PSI. The overall survival free of surgery at 1 and 5 years was 53.0% (95% CI 434.7-63.0) and 37.1% (95% CI 29.1-47.1), respectively. BMI >35 (p=0.04, HR 3.3) was predictive for late conversion to surgery. Age, gender, occupation, or history of glenohumeral dislocation were not significant. Assessing surgery as a time dependent covariate, a patient undergoing surgery was at an increased risk for radiographic progression of osteoarthritis (p=0.02, HR=4.0, 95% CI 1.2-13.2). Conclusion: Conservative management was performed for at least one year in over half of patients diagnosed with PSI. However, long-term follow-up demonstrates that nearly 40% of these patients eventually require surgery. Increased BMI was predictive for late failure of while age, gender, history of dislocation and occupation did not show an effect. Patients who underwent surgery were at an increased risk of radiographic progression of arthritis.

scholarly journals Distal Tibial Allograft Augmentation for Posterior Shoulder Instability Associated With Glenoid Bony Deficiency: A Case Series

2020 ◽  
Vol 2 (6) ◽  
pp. e743-e752
Author(s):  
Ron Gilat ◽  
Eric D. Haunschild ◽  
Tracy Tauro ◽  
Aghogho Evuarherhe ◽  
Michael C. Fu ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Case Series ◽  
Posterior Shoulder Instability ◽  
Posterior Shoulder

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

2019 ◽  
Vol 47 (3) ◽  
pp. 682-687 ◽  
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.

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

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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