Clinical Outcomes and Return to Play in Dynamic Anterior Glenohumeral Capsular Ligament Tensioning Procedure for Overhead-throwing Athletes with Traumatic Shoulder Dislocation on the Throwing Side

Abstract

BackgroundAlthough arthroscopic Bankart repair for shoulder instability after a traumatic shoulder dislocation is a standard procedure, return-to-play rates for overhead-throwing athletes with shoulder instability on the throwing side have been reported to be lower than those in non-overhead athletes or in non-throwing shoulders. A recent technical report showed that the dynamic anterior glenohumeral capsular ligament tensioning (DAGHT) procedure in abducted external rotation, which mimics the late cocking phase of the throwing motion during surgery, may provide optimal tensioning of the anterior glenohumeral ligament. This study compared clinical outcomes and return to play after arthroscopic Bankart repair between DAGHT and a conventional procedure for overhead-throwing athletes with traumatic dislocation on the throwing side. MethodsWe retrospectively examined patients with traumatic anterior shoulder dislocation who underwent arthroscopic Bankart repair. The inclusion criteria were being an overhead-throwing athlete, having the injury on the throwing side, evidence of anterior shoulder dislocation, and evidence of Bankart lesions on magnetic resonance imaging. Clinical scores were evaluated using Jobe’s postoperative grading system; the Kerlan–Jobe Orthopaedic Clinic (KJOC) Overhead Athletes Shoulder and Elbow Score; the Western Ontario Shoulder Instability Index (WOSI); the Disabilities of the Arm, Shoulder, and Hand (DASH) sports module; return to play; and return to the same level. ResultsThirty-four patients (eight females and 26 males; mean age, 18.0±4.0 years) were divided into two groups: 16 with shoulder stabilization in the resting position (control group) and 18 with shoulder stabilization with DAGHT (DAGHT group). Jobe’s score was significantly greater in the DAGHT group than in the control group (88.9% and 18.8% in excellent rate, respectively; P<.001). External rotation at abduction and the KJOC, WOSI, and DASH scores were significantly greater in the DAGHT group than in the control group (94.5 vs. 85.0; 81.1 vs. 55.7; 83.8 vs. 58.4; 11.8 vs. 27.0; P=.008, <.001, <.001, and =.019, respectively). Although return-to-play rates were not significantly different between the control and DAGHT groups (93.8% vs. 100%; P=.47), return-to-the-same-level rates were significantly better in the DAGHT group than in the control group (77.8% vs. 37.5%; P=.035). ConclusionArthroscopic shoulder stabilization with the DAGHT procedure on the throwing side of overhead-throwing athletes resulted in lesser restriction of external rotation, better clinical outcomes, and higher return-to-the-same-level rate than arthroscopic shoulder stabilization with conventional tensioning. The DAGHT procedure in abduction and external rotation may represent a solution for a traumatic shoulder instability on the throwing side in overhead-throwing athletes. Level of EvidenceLevel III; Retrospective Cohort Comparison; Treatment Study