Concomitant Rotator Cuff Tears in Throwing Athletes with Posterior Instability Are Common but Do Not Effect Surgical Outcomes

Abstract

One previous study found that throwing athletes with SLAP and concomitant rotator cuff tears had significantly poorer outcome scores and return to play compared with those with SLAP tears only. Posterior shoulder instability is also common in throwing athletes, however, no studies exist reporting outcomes of these patients with concomitant rotator cuff tears. We hypothesize that throwers treated with arthroscopic capsulolabral repair for posterior shoulder instability with coexistent rotator cuff pathology will have poorer outcome scores and return to play. Fifty-six male over-head throwing athletes with unidirectional posterior shoulder instability who were reviewed. Pre- and post-operative patient centered outcomes of pain, stability, function, ROM, strength, and ASES scores as well as return-to-play were evaluated. Patients with and without rotator cuff pathology were compared. All athletes with rotator cuff pathology were treated with arthroscopic debridement. Twenty-four throwers of 56 were found to have rotator cuff pathology in addition to posterior capsulolabral pathology at average 3-year follow-up. There were no differences between those with and without rotator cuff tears in regards to pre- and post-operative patient centered outcomes including pain, stability, function, ROM, strength, and ASES scores. Return to play rates were no different, and 92% with concomitant rotator cuff tears returned to sport while 67% returned to the same level. Unlike a previous study evaluating throwing athletes’ outcomes after a SLAP tear with rotator cuff tears, throwers with posterior shoulder instability and concomitant rotator cuff tears showed no difference with respect to patient-reported outcome measures or return to play. This suggests arthroscopic posterior capsulolabral repair with rotator cuff debridement is a successful technique to manage posterior shoulder instability with concomitant rotator cuff tears.