Recurrence Rates Following Arthroscopic Shoulder Stabilization are Improved Following a Criteria Based Return to Sport Testing Protocol

Objectives: Recurrent shoulder instability after arthroscopic shoulder stabilization is a challenging complication that often manifests after return to sports. Many physicians use an arbitrary minimum of 5 months from surgery for clearance, although there is little data to support the use of temporal based criteria. Prior literature on ACL reconstruction has demonstrated overwhelming evidence for improved failure rates following return to sport after criteria based testing compared to time based clearance, but no such studies to date have evaluated the use of objective return to play testing protocols on recurrence rates following arthroscopic shoulder stabilization. We have prior presented on a return to sport criteria-based protocol that has demonstrated that a majority of athletes have residual strength and functional limitations which would preclude them from full clearance and return to play at 6 months postoperatively. The purpose of this study is to analyze the impact of a return to play criteria-based testing protocol on recurrent instability following arthroscopic shoulder stabilization. We hypothesized that patients who meet return to play criteria would have less recurrent instability compared to those who did not undergo the testing and were cleared to return based on time from surgery. Methods: Forty eight patients (group I) who underwent arthroscopic shoulder stabilization surgery from 2016 to 2018 with minimum 1 year follow up and were referred during postoperative rehabilitation for functional testing to evaluate readiness for return to sport were included in this retrospective case controlled study. These patients were compared to a control group of forty-eight historical consecutive cases (group II) who did not undergo return to sports testing and were cleared for sports after a minimum of 5 months following surgery. Patients with critical glenoid bone loss or off-track Hill-Sach’s lesions necessitating a remplissage or bone augmentation procedure were excluded from the study. ANOVA and independent t test were performed to analyze recurrence shoulder instability rates defined as dislocations or subluxation symptoms. Results: There was no difference between groups with regard to age ( p=0.64), sex (p=0.24), hand dominance (p=0.84), or participation in contact sports (p=0.66). Patients who underwent return to play criteria based testing protocol had a statistically significant difference in the rate of recurrent shoulder instability (10% vs. 31%, odds ratio=3.9, p<0.001). Conclusion: Athletes who undergo an objective return to play criteria based testing protocol have lower rates of recurrent instability following arthroscopic shoulder stabilization surgery than those cleared by time from surgery. Based on our findings, we strongly recommend the utilization of a criteria based testing protocol for return to play following arthroscopic shoulder stabilization, particularly for sports that have known higher risks of recurrence.

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Arthroscopic Shoulder Stabilization in the High-Risk Young Athlete: Return to Sport and Second Surgery Rates

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00117 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0011

Author(s):

Frank A. Cordasco ◽

Brian Lin ◽

Daphne Ling ◽

Jacob G. Calcei

Keyword(s):

High Risk ◽

Revision Surgery ◽

Shoulder Instability ◽

Return To Sport ◽

Young Athlete ◽

High Rate ◽

Shoulder Stabilization ◽

Recurrent Instability ◽

Arthroscopic Shoulder Stabilization ◽

Second Surgery

Objectives: Shoulder instability in the young athlete has become an increasingly significant clinical problem in recent years. This high-risk population of athletes less than 25 years of age is a difficult cohort to manage because they have high failure rates with non-operative treatment and they reportedly have the lowest return to sport (RTS) rates and highest second surgery rates following arthroscopic shoulder stabilization compared to older patients. The purpose of this retrospective study is to evaluate the two-year clinical outcomes of a cohort of high-risk athletes less than or equal to 22 years of age following arthroscopic shoulder stabilization with a focus on RTS and incidence of second surgery. Methods: The primary outcomes evaluated were RTS and revision surgery following arthroscopic shoulder stabilization performed by the senior author at minimum follow-up of 24 months. Athletes were excluded if they had > 5 pre-operative episodes of instability, significant bone loss or had primary posterior instability. Demographic data was recorded including age, sex, BMI, last recorded range of motion, # episodes of recurrent instability, and revision surgery. A brief survey was completed regarding their shoulder instability history, sports prior to surgery, sports returned to following surgery, satisfaction with and level of RTS, time at which return to sports was achieved, recurrent instability, revision operations, and single assessment numeric evaluation (SANE) score. Results: A total of 67 athletes met inclusion criteria, with a mean age of 17.4 years (range, 13-22 years). There were 19 females (28%) and 48 males (72%). The mean number of instability events was 2 (range 0-5), 57% in the dominant arm and 43% in the non-dominant arm. Evaluation of RTS, demonstrated that 59 (88%) were able to RTS with 56 (84%) of those returning to the same level or higher, while 8 (12%) patients did not RTS for reasons other than recurrent instability or apprehension. Among the 59 patients who RTS, the average time to return was 7.3 months (range: 5-12 months) and baseball and football were the most common sports. There was a gender specific difference with respect to RTS and revision surgery. The male RTS rate was 94% compared to the female rate of 74%. Four of 67 (6%) patients underwent revision stabilization 11 to 36 months for recurrent instability, however all were male athletes 4/48 (8%). There were no female athletes who required revision surgery. Patient reported mean SANE score was 88 (SD, ±15). Conclusion: Shoulder instability in the young high-risk athlete is a complex problem with a relatively high rate of recurrence and revision surgery in the literature. In our case series, we found a relatively low reoperation rate (6%) with a high rate of RTS (88%), at an average time of 7.3 months. There was a gender specific difference with respect to RTS and revision surgery. The male RTS rate was 94% and revision surgery rate was 8% (4/48) while the female RTS rate was 74% and revision surgery rate was 0%. The athletes reported a return to near full function with an average SANE score of 88. We believe the improved outcomes in this cohort of high risk young athletes are related to the pre-operative selection criteria excluding those athletes with a greater number of pre-operative episodes of instability and those with significant bone loss and bipolar lesions as open stabilization and bone augmentation (Latarjet) are more predictable operations in athletes with these risk factors.

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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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ARTHROSCOPIC SHOULDER STABILIZATION IN HIGH SCHOOL FOOTBALL PLAYERS: RECURRENT INSTABILITY WITH RETURN TO CONTACT SPORT

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00247 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0024

Author(s):

Jessica Stambaugh ◽

Eric Edmonds ◽

Andrew Pennock

Keyword(s):

High School ◽

Shoulder Instability ◽

Shoulder Arthroscopy ◽

Football Players ◽

High School Football ◽

Shoulder Stabilization ◽

Recurrent Instability ◽

Contact Sports ◽

Arthroscopic Shoulder Stabilization ◽

Chi Square Analysis

Background: The etiology of recurrent shoulder instability after arthroscopic surgery in the high school American football population remains unknown. Purpose/Hypothesis: To determine the risk of recurrent instability after shoulder arthroscopy upon return to competitive football. The hypothesis was that the rate of recurrence would be greater in high school players with more years of eligibility remaining (YER), suggesting greater likelihood of return to football after surgery. Methods: Consecutive male high school football players with at least one year of eligibility remaining who sustained traumatic in-season shoulder instability episode(s) and underwent arthroscopic labral stabilization by two Orthopaedic Sports surgeons at Rady Children’s Hospital San Diego between 2012 and 2017 were identified. 64 subjects aged 14-17 met inclusion criteria of which 45 were able to be contacted and included in analyses. Average follow up period was 4.06 years. Patients and/or families were contacted by phone to discuss (1) recurrent instability episodes and (2) return to competitive sport and/or recreational athletic activity. Statistics were conducted using chi square analysis to compare recurrence of instability with return to sport. Results: Surgery itself was career ending in 50% of cases due to reported fear of recurrent football-related injury. The hypothesis that career longevity in terms of years of eligibility remaining (YER) affects return to game play in this young active population remains unclear although preliminary results suggest positive exponential correlation. Comparative analysis demonstrates a statistically significant difference between rate of recurrence in high school football players that return to contact sports vs transition to non-contact activity after arthroscopic shoulder stabilization. Interestingly, football players who concurrently played baseball during high school demonstrated decreased risk of postoperative instability episodes. Conclusion: Risk of recurrent instability after shoulder arthroscopy is increased in high school football players who return to competitive contact sports whereas transition to non-contact and/or recreational activity likely confers protective effect. High school football players who play baseball may derive functional benefit from cross training. [Figure: see text]

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Outcomes of the Latarjet Procedure Versus Free Bone Block Procedures for Anterior Shoulder Instability: A Systematic Review and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546520925833 ◽

2020 ◽

pp. 036354652092583

Author(s):

Ron Gilat ◽

Eric D. Haunschild ◽

Ophelie Z. Lavoie-Gagne ◽

Tracy M. Tauro ◽

Derrick M. Knapik ◽

...

Keyword(s):

Systematic Review ◽

Shoulder Instability ◽

Meta Analysis ◽

Anterior Shoulder Instability ◽

Bone Block ◽

Return To Sports ◽

Latarjet Procedure ◽

Shoulder Stabilization ◽

Recurrent Instability

Background: Free bone block (FBB) procedures for anterior shoulder instability have been proposed as an alternative to or bail-out for the Latarjet procedure. However, studies comparing the outcomes of these treatment modalities are limited. Purpose: To systematically review and perform a meta-analysis comparing the clinical outcomes of patients undergoing anterior shoulder stabilization with a Latarjet or FBB procedure. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, Embase, and the Cochrane Library databases were systematically searched from inception to 2019 for human-participants studies published in the English language. The search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement including studies reporting clinical outcomes of patients undergoing Latarjet or FBB procedures for anterior shoulder instability with minimum 2-year follow-up. Case reports and technique articles were excluded. Data were synthesized, and a random effects meta-analysis was performed to determine the proportions of recurrent instability, other complications, progression of osteoarthritis, return to sports, and patient-reported outcome (PRO) improvement. Results: A total of 2007 studies were screened; of these, 70 studies met the inclusion criteria and were included in the meta-analysis. These studies reported outcomes on a total of 4540 shoulders, of which 3917 were treated with a Latarjet procedure and 623 were treated with an FBB stabilization procedure. Weighted mean follow-up was 75.8 months (range, 24-420 months) for the Latarjet group and 92.3 months (range, 24-444 months) for the FBB group. No significant differences were found between the Latarjet and the FBB groups in the overall random pooled summary estimate of the rate of recurrent instability (5% vs 3%, respectively; P = .09), other complications (4% vs 5%, respectively; P = .892), progression of osteoarthritis (12% vs 4%, respectively; P = .077), and return to sports (73% vs 88%; respectively, P = .066). American Shoulder and Elbow Surgeons scores improved after both Latarjet and FBB, with a significantly greater increase after FBB procedures (10.44 for Latarjet vs 32.86 for FBB; P = .006). Other recorded PRO scores improved in all studies, with no significant difference between groups. Conclusion: Current evidence supports the safety and efficacy of both the Latarjet and FBB procedures for anterior shoulder stabilization in the presence of glenoid bone loss. We found no significant differences between the procedures in rates of recurrent instability, other complications, osteoarthritis progression, and return to sports. Significant improvement in PROs was demonstrated for both groups. Significant heterogeneity existed between studies on outcomes of the Latarjet and FBB procedures, warranting future high-quality, comparative studies.

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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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Risk of Recurrent Instability After Arthroscopic Stabilization for Shoulder Instability in Adolescent Patients

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119868995 ◽

2019 ◽

Vol 7 (9) ◽

pp. 232596711986899 ◽

Cited By ~ 6

Author(s):

Jonathan Kramer ◽

Gio Gajudo ◽

Nirav K. Pandya

Keyword(s):

Shoulder Instability ◽

Sports Participation ◽

High Rate ◽

Anterior Shoulder Instability ◽

Failure Rates ◽

Shoulder Stabilization ◽

Recurrent Instability ◽

Radiographic Findings ◽

Arthroscopic Shoulder Stabilization ◽

Adolescent Patients

Background: With the rise of adolescent sports participation, there has been a concomitant increase in not only the incidence but also the treatment of traumatic shoulder instability. Yet, there have been limited data on the failure rates of arthroscopic shoulder stabilization in this population as well as the potential risk factors. Purpose/Hypothesis: The purpose of this study was to determine the failure rates of adolescent patients who underwent arthroscopic labral reconstruction for traumatic anterior shoulder instability. We hypothesized that adolescent failure rates would be significantly higher than what has been reported in the adult population with regard to recurrent instability after surgical intervention. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective cohort study performed at a single center. Inclusion criteria consisted of all adolescent-aged patients identified who (1) had traumatic anterior shoulder instability, (2) had radiographic findings consistent with anteroinferior capsulolabral injury, and (3) underwent arthroscopic shoulder stabilization. Patient demographics, clinical presentation, imaging, intraoperative findings, and postoperative outcomes were analyzed. Results: A total of 36 patients were identified, with a mean ± SD follow-up of 35.6 ± 13.8 months. The mean patient age at the time of the index procedure was 16.03 ± 1.67 years. All patients underwent arthroscopic shoulder stabilization consisting of arthroscopic Bankart repair. Twelve patients (33.3%) reported either recurrent instability or apprehension, of whom 9 (25.0%) developed recurrent dislocation/subluxation at a mean of 20.67 months postoperatively (range, 16-51 months). No single sport was associated with a statistically significant increased risk of redislocation, although a trend was seen toward those with postoperative participation in high-risk sporting activity. Patients who redislocated their shoulders had a higher frequency of a Hill-Sachs lesion on magnetic resonance imaging (89%) compared with those who did not (52%, P = .048). History of multiple preoperative dislocations, presence of bony Bankart pathology, off-track lesions, and number of anchors utilized were not associated with postoperative dislocation/subluxation. Conclusion: This study demonstrates that adolescent patients treated with arthroscopic shoulder stabilization have a high rate of recurrent instability. The adolescent population may benefit from other stabilization strategies and/or activity modification. Further studies are necessary to determine the reasons for the high rate of redislocation and to develop strategies for prevention.

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Return to Play After the Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546519831005 ◽

2019 ◽

Vol 47 (12) ◽

pp. 3002-3008 ◽

Cited By ~ 13

Author(s):

Eoghan T. Hurley ◽

Connor Montgomery ◽

M. Shazil Jamal ◽

Yoshiharu Shimozono ◽

Zakariya Ali ◽

...

Keyword(s):

Systematic Review ◽

Shoulder Instability ◽

Return To Play ◽

Rate Of Return ◽

Cochrane Library ◽

Anterior Shoulder Instability ◽

Return To Sports ◽

Latarjet Procedure ◽

Recurrence Rates ◽

Overhead Athletes

Background: Traumatic anterior shoulder instability is a common clinical problem among athletic populations. The Latarjet procedure is a widely used treatment option to address shoulder instability in high-demand athletes at high risk of recurrence. However, rates and timing of full return to sports have not been systematically analyzed. Purpose: To systematically review the evidence in the literature to ascertain the rate and timing of return to play and the availability of specific criteria for safe return to play after the Latarjet procedure. Study Design: Systematic review. Methods: A systematic literature search was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the EMBASE, MEDLINE, and Cochrane Library databases. Eligible for inclusion were clinical studies reporting on return to play after the Latarjet procedure. Statistical analysis was performed by use of SPSS. Results: Our review found 36 studies including 2134 cases meeting our inclusion criteria. The majority of patients were male (86.9%), with a mean age of 25.4 years (range, 15-59 years) and a mean follow-up of 83.5 months. The overall rate of return to play was 88.8%, with 72.6% returning to the same level of play. Among collision athletes, the overall rate of return to play was 88.2%, with 69.5% returning to the same level of play. In overhead athletes, the overall rate of return to play was 90.3%, with 80.6% returning to the same level of play. The mean time to return to play was 5.8 months (range, 3.2-8 months). Specific return to play criteria were reported in the majority of the studies (69.4%); time to return to sport was the most commonly reported item (66.7%). Conclusion: The overall rate of return to play was reportedly high after the Latarjet procedure. However, almost a fifth of athletes returning to sports were not able to return at the same level. Further development of validated criteria for safe return to sports could potentially improve clinical outcomes and reduce recurrence rates.

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

The American Journal of Sports Medicine ◽

10.1177/0363546517712505 ◽

2017 ◽

Vol 45 (11) ◽

pp. 2540-2546 ◽

Cited By ~ 36

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.

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Outcomes of the Latarjet procedure with minimum 5- and 10-year follow-up: A systematic review

Shoulder & Elbow ◽

10.1177/1758573220945318 ◽

2020 ◽

Vol 12 (5) ◽

pp. 315-329

Author(s):

Ron Gilat ◽

Ophelie Lavoie-Gagne ◽

Eric D Haunschild ◽

Derrick M Knapik ◽

Kevin C Parvaresh ◽

...

Keyword(s):

Shoulder Instability ◽

Return To Sport ◽

Anterior Shoulder Instability ◽

Return To Sports ◽

Latarjet Procedure ◽

Recurrent Instability ◽

Follow Up Studies ◽

Long Term Follow Up

Background The purpose of this study was to evaluate mid- and long-term outcomes following the Latarjet procedure for anterior shoulder instability. Methods PubMed, MEDLINE, Embase, and Cochrane libraries were systematically searched, in line with PRISMA guidelines, for studies reporting on outcomes following the Latarjet procedure with minimum five-year follow-up. Outcomes of studies with follow-up between 5 and 10 years were compared to those with minimum follow-up of 10 years. Results Fifteen studies reporting on 1052 Latarjet procedures were included. Recurrent instability occurred in 127 patients, with an overall random summary estimates in studies with a minimum five-year follow-up of 0–18% (I2 = 90%) compared to 5–26% (I2 = 59%) for studies with a minimum 10-year follow-up. Overall rates for return to sports, non-instability related complications, and progression of arthritis estimated at 65–100% (I2 = 87%), 0–20% (I2 = 85%), and 8–42% (I2 = 89%) for the minimum five-year follow-up studies and 62–93% (I2 = 86%), 0–9% (I2 = 28%), and 9–71% (I2 = 91%) for the minimum 10-year follow-up studies, respectively. All studies reported good-to-excellent mean PRO scores at final follow-up. Conclusions The Latarjet is a safe and effective procedure for patients with shoulder instability. The majority of patients return to sport, though at long-term follow-up, a trend towards an increased incidence of recurrent instability is appreciated, while a significant number may demonstrate arthritis progression.

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