Procedure In Athletes Research Articles

AB116. SOH24AB_254. Open Latarjet procedure in athletes with a minimum of 5 years follow up: an analysis of factors associated with success

AB116. SOH24AB_254. Open Latarjet procedure in athletes with a minimum of 5 years follow up: an analysis of factors associated with success

O254: Open Latarjet Procedure in Athletes With a Minimum of 5 Years Follow Up: An Analysis of Factors Associated With Success

Abstract Introduction The open Latarjet (OL) procedure has shown excellent return to play (RTP) and low recurrence in athletes but there is limited published evidence for long term outcomes. The purpose of this study was to evaluate the outcomes of athletes 5-years post-operatively following the OL procedure. Methods A retrospective review of athletes who underwent OL under a single surgeon with a minimum of 5-year follow-up was performed. Multi-linear regression models were used to evaluate factors affecting postoperative satisfaction, and SSV level. Results 141 shoulder in 132 male athletes who underwent OL were included, with a mean age of 22.9 years, with mean follow-up of 71.5months. At final follow up, 93.7% were satisfied/very satisfied, and the mean SSV was 85.5. Overall, the rate of RTP was 91.3%, with 80.8% returning at the same level at a mean of 7.3months. There were 9 athletes (6.4%) who experienced further dislocation, all during collision sports. In total 10 (7.1%) athletes had a further operation, of which 3 (2.4%) were for recurrent instability. The mean SIRSI score was 82.1 ± 27.3, the mean Rowe score was 85.4, while the mean VAS score was 2.1. Linear regression revealed the SIRSI, VAS and Rowe score as well as RTP were significantly associated with SSV score. 90.6% of athletes reported they would undergo the procedure again were it required. Conclusion There was very high rate of satisfaction, with excellent patient-reported outcomes, low rates of recurrent instability and a high rate of return to play among athletes.

Poster 176: International Expert Consensus on Return to Sport Criteria Following Shoulder Stabilization Surgery: A Delphi Study

Objectives:A comprehensive approach to standardize the criteria of return to sport (RTS) following common shoulder procedure in athletes is required to safely return the physically active population to sport postoperatively. There is lack of studies validating the RTS criteria following arthroscopic and/or open shoulder stabilization surgery. We developed a list of widely accepted criteria of RTS following shoulder stabilization surgery using Delphi consensus methods with international experts.Methods:A working group developed a list of approximately 50 criteria. Experts included 27 world renowned shoulder surgeons from various countries who have been recognized as international experts in the field and were invited speakers to international sports medicine meetings rated their agreement to each of the listed criteria. Experts were surveyed on 3 occasions to establish consensus on the inclusion of each RTS criterion in the final list of accepted criteria of RTS after shoulder stabilization surgery. For each round, a 70% agreement was used as a cutoff for consensus. Statements without this level of agreement were excluded in subsequent rounds. Descriptive statistics were used for analysis. Predefined criteria were used to refine item lists after each survey. Final list of criteria of RTS following shoulder stabilization surgery was complied by the working group and included those that received > 75% agreement on all 3 rounds of rating by experts.Results:We initially identified 50 RTS criteria following shoulder stabilization surgery from the literature that the experts were asked to rate their agreement. Twenty-seven international experts completed the rating in all 3 rounds. The RTS criteria were divided consisted of 5 subgroups including current evidence, ideal characteristics of the RTS criteria, general considerations for RTS criteria, specific considerations for RTS criteria, and dissemination of RTS criteria following shoulder stabilization. For Round 1, the response rate was 100% and 10 (20%) of 47 criteria were eliminated leaving 37 statements for evaluation in Round 2. Round 2 had a 100% response rate, and 1 (2.5%) statement was eliminated leaving 36 criteria for the final round. Round 3 had a 96% response rate, and no statements were eliminated. Respondents agreed on a total 36 statements to define the RTS criteria following shoulder stabilization in athletes. Table 1 provides the final list of accepted criteria and the percentage of agreement for each individual criterion.Conclusions:The final list of statements agreed upon by international experts provide insight into a standardized return to sport criteria following shoulder stabilization surgery in physically active patients. This agreed upon criteria can aid those providing care to athletes in their decision making when determining optimal timing for return to sport.Table 1.Statements that reached an expert consensus above 70% in 3 rounds.

Timing of postoperative weightbearing in the treatment of traumatic chondral injuries of the knee in athletes - A systematic review of current concepts in clinicalpractice

BackgroundSurgery aims to stimulate healing and enable a safe return to sport in athletes with symptomatic cartilage lesions of the knee. Timing of postoperative weightbearing is crucial, balancing a stimulation of the healing and avoiding reinjury.To explore current concepts of timing to partial and full weightbearing and rate of return to sport in athletes after articular cartilage surgery of the knee.Systematic Review of studies with level of evidence I-III MethodsFour databases (Pubmed, Web of Science, Scopus and Embase) were searched using a predetermined keyword strategy. Two independent reviewers screened results according to inclusion and exclusion criteria. Modified Coleman Methodology Score (mCMS) was used for the quality assessment. Results5294 records were found. Data from ten studies was extracted after duplicate removal, title and abstract screening and full-text evaluation. Eight of the ten studies included a detailed rehabilitation protocol, including 336 out of a total athletic population of 401. 62% began partial weightbearing (PWB) 1–2 weeks postoperatively, while 38% began within 3–4 weeks. The studies that had a later PWB all returned to full weightbearing (FWB) within 6–8 weeks. One study with early PWB returned to early FWB, while the other two returned 10–12 weeks postoperatively. “Return to Sport” (RTS) was the most common reported outcome measure, with most studies reporting RTS at 80% or higher. ConclusionThere is no clear evidence that the timing of weightbearing (WB) affects the outcome and return to sport in athletes after surgery for focal full-thickness cartilage lesions of the knee. On the other hand, there seems to be no adverse effects in adopting an early WB strategy, currently defined differently by different authors. Further studies directly comparing the timing of WB for specific surgical procedures in athletes and with relevant control groups is recommended. There is a need for a consensus in regard to more exactly defining “early” vs “late” weightbearing in relation to a universal and precisely defined state of healing.

Arthroscopic Bankart Repair Versus Open Latarjet for First-Time Dislocators in Athletes.

Background:In athletes with a first-time shoulder dislocation, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are the most commonly utilized surgical procedures to restore stability and allow them to return to play (RTP).Purpose:To compare the outcomes of ABR and OL in athletes with a first-time shoulder dislocation.Study Design:Cohort study; Level of evidence, 3.Methods:We performed a retrospective review of patients with first-time shoulder dislocation who underwent primary ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. Patients who underwent ABR were pair-matched in a 2:1 ratio with patients who underwent OL by age, sex, sport, and level of preoperative play. The rate, level, and timing of RTP, as well as the Shoulder Instability–Return to Sport after Injury (SIRSI) score were evaluated. Additionally, we compared recurrence, visual analog scale pain score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the surgery again.Results:Overall, 80 athletes who underwent ABR and 40 who underwent OL were included, with a mean follow-up of 50.3 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, or recurrent dislocation rate. There were also no differences between ABR and OL in patient-reported outcome scores or patient satisfaction. When collision athletes were compared between ABR and OL, there were no differences in RTP, SIRSI score, or redislocation rate.Conclusion:ABR and OL resulted in excellent clinical outcomes, with high rates of RTP and low recurrence rates. Additionally, there were no differences between the procedures in athletes participating in collision sports.

Open Latarjet Procedure in Athletes Following Failed Prior Instability Surgery Results in Lower Rates of Return to Play

The purpose of this study was to compare the outcomes of open Latarjet (OL) in competitive athletes with primary shoulder instability versus those with recurrent instability versus those undergoing OL for failed prior instability surgery. A retrospective review of patients who underwent OL with a minimum of 24-month follow-up was performed. Additionally, these were pair-matched in a 1:2:1 ratio for age, gender, sport, level of preoperative play, and follow-up length for primary instability, recurrent instability and failed prior instability surgery. Return to sport, the level of return and the timing of return were assessed. Additionally, recurrence, Visual Analogue Scale for pain (VAS), Subjective Shoulder Value (SSV), Rowe score, Shoulder Instability-Return to Sport after Injury (SIRSI) score, satisfaction, and whether they would undergo the same surgery again were compared. After pair-matching, a total of 200 patients were included, with a mean age of 22.7 years and a mean follow-up of 38.8 months. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SIRSI, SSV) used for the 3 groups (P > 0.05 for all). However, there was a significantly lower rate of return to play for those undergoing OL because of failed prior instability surgery (88% vs 91% vs 64%, P < 0.0001) and for return at the same or a higher level (66% vs 78% vs 56%, P= 0.02). There was no significant difference in the rate of recurrent instability among the 3 groups (6% vs 5% vs 6%, P= 0.95). OL results in excellent clinical outcomes and low recurrence rates for those with primary shoulder instability, those with recurrent instability and those undergoing OL for failed prior instability surgery. However, in those undergoing OL for failed prior stabilization surgery, there was a lower rate of return to play. Level III: Retrospective Comparative Study.

Are the Classic and the Congruent Arc Latarjet Procedures Equally Effective for the Treatment of Recurrent Shoulder Instability in Athletes?

Background: There is a lack of evidence in the literature comparing outcomes between the classic and the congruent arc Latarjet procedures in athletes. Purpose: To compare return to sports, functional outcomes, and complications between the classic and the congruent arc Latarjet procedures in athletes with recurrent glenohumeral instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2009 and June 2017, 145 athletes with recurrent anterior glenohumeral instability underwent surgery with the Latarjet as a primary procedure in our institution. The classic procedure was used in 66 patients, and the congruent arc method was used in 79 patients. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale (VAS) for pain in sports activity, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. Results: In the total population, the mean follow-up was 41.3 months (range, 24-90 months) and the mean age was 25.3 years (range, 18-45 years). In total, 90% of patients were able to return to sports; of these, 91% returned at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistical improvement after operation (P < .001). The Rowe score increased from a preoperative mean of 42.8 points to a postoperative mean of 95.2 points (P < .01). Subjective pain during sports improved from 3.2 points preoperatively to 0.7 points at last follow-up (P < .01). The ASOSS score improved significantly from a preoperative mean of 46.4 points to a postoperative mean of 88.4 points (P < .01). No significant differences in shoulder ROM and functional scores were found between patients who received the classic vs congruent arc procedures. There were 5 recurrences (3.5%): 3 dislocations (2%) and 2 subluxations (1%). No significant difference in the recurrence rate was noted between groups. The bone block healed in 134 cases (92%). Conclusion: In athletes with recurrent anterior glenohumeral instability, the Latarjet procedure produced excellent functional outcomes. Most athletes returned to sports at their preinjury level, and the rate of recurrence was very low, regardless of whether the patients received surgery with the classic or congruent arc technique.

National Basketball Association combine performance after a partial meniscectomy.

An arthroscopic meniscectomy is one of the most common orthopedic procedures in athletes. Return to play rates and deficits in muscle function have been reviewed after meniscectomy, but no study has reviewed functional performance after an isolated partial meniscectomy. To compare the performance of elite-level basketball players after a partial meniscectomy to a control group of players with no previous reported knee injury. We believe that there is no difference between the two groups in functional performance. Case Series. Functional performance results from the National Basketball Association (NBA) combine were reviewed between 2000 and 2015. Twelve out of 1092 players were found to have undergone a partial meniscectomy prior to competing in the NBA combine. The partial meniscectomy group was compared to an age-, size-, and position-matched control group with respect to functional performance testing such as the shuttle run test, lane agility test, ¾ court sprint, vertical jump (no step), and vertical jump (max). The meniscectomy and the control groups that there was no significant difference between the two groups in agility, quickness, sprinting, and jumping ability. However, there was a - 0.596 spearman correlation between months after surgery and agility (p = 0.041), while there was a + 0.690 and + 0.650 spearman correlation between both months after surgery and standing vertical and max vertical (p = 0.013 and p = 0.022). Athletes competing in the NBA combine who have undergone a partial meniscectomy perform as well as uninjured athletes in all NBA combine performance testing. Furthermore, as athletes are further out from surgery, they have an improvement in both standing and max vertical jump.

Capsular management in the arthroscopic treatment of the femoro-acetabular impingement in athletes: our experience.

Background and aim of the work:In the last decade, thanks to the improvement of the surgical techniques, arthroscopic treatment of hip diseases has significantly spread and evolved and currently it represents the gold standard for the treatment of femoral-acetabular impingement. In the recent years, the function of the joint capsule (and therefore the results of an arthroscopic capsulotomy) has been better understood, opening a heated debate. The Literature is still torn about a proper capsular management and the need for a capsular suture, but latest studies are more oriented to its execution at the end of the surgical procedure. According to these recent studies, the joint capsule performs an essential function on primary stability, so a conservative capsulotomy and its final closure are therefore reccomended to restore the native anatomy and physiology. Although capsular management remains a controversial topic, in recent years we have developed a new conservative capsulotomy technique associated with a final capsular suture. The aim of the present retrospective study is to assess the influence of different capsulotomy techniques and a possible capsular suture role on the patient’s functional outcome in a cohort of patients with femoral-acetabular impingement arthroscopically treated.Hypothesis:Our hypothesis is that a conservative “longitudinal” capsulotomy with a proper capsular suture positively influences the patient’s functional outcome in athletes.Methods:36 patients (competitive athletes) treated with hip arthroscopy for femoral-acetabular impingement have been retrospectively enrolled at the Orthopaedic Clinic of Academic Hospital of Udine during a period of two years (2016-2018); collected data have been analyzed and compared with a retrospective model. Patients have been divided into three equivalent groups, 12 without a suitable capsular management (T-Capsulotomy technique), 12 performing a Longitudinal Capsulotomy but without a final suture and 12 treated with a conservative Longitudinal Capsulotomy and a capsular suture. Patient’s post-operative functional outcome has been analysed using the modified Harris Hip Score (mHHS), the Hip Outcome Score-Activity of Daily Living (HOS-ADL) and the Hip Outcome Score-Sport Scale (HOS-SS). Return to sport.Results:In our series there was no statistically significant difference in functional scores, however longitudinal capsulotomy seems to be associated with a higher percentage of return to sports activity (91,6% vs 75%).Conclusions:The new longitudinal shape capsulotomy technique and a capsular suture with a single side-to-side stitch at the end of the procedure in athletes can positively influence the patient’s functional outcome. (www.actabiomedica.it)

Return to sports after the latarjet procedure: high return level of non-collision athletes.

The purpose of this study was to compare the clinical outcomes, including the level of return to sport, of collision and non-collision athletes who had the Latarjet procedure. A total of 56 shoulders of 29 collision and 27 non-collision athletes were retrospectively analyzed. All study participants underwent the Latarjet procedure between 2007 and 2014. Median age at the time of surgery was 26.5years(18-43) and follow-up duration was 67.0months(24-113). At the final follow-up, 54 (96.4%) patients returned to sports. Nine patients (16.1%) returned to the same level of sports. In a group of collision athletes, 1 patient (3.4%) returned to the same level, 16 (55.2%) returned to lower level, 10 (34.5%) changed sports, and 2 (6.9%) quit sports. In a group of noncollision athletes, 8 (29.6%) returned to same level, 11 (40.7%) returned at a lower level and 8 (29.6%) changed sports. The level of return to sports in collision group was statistically different from that in noncollision group (p = 0.046). The mean VAS, Rowe and UCLA scores improved significantly in both groups (p < 0.001) with no statistically significant difference between both groups. Although the clinical outcomes were not significantly different between collision and non-collision athletes, the level of return to sports was significantly higher in the non-collision group than in the collision group. The result suggests that the level of physical demand according to sport type is an important prognostic factor which predicts the level of return to sport after the Lartarjet procedure in athletes. IV.

Treatment of chronic lateral ankle instability using the Broström-Gould procedure in athletes: long-term results.

this study was conducted to evaluate long-term results following treatment of chronic lateral ankle instability using the Broström-Gould technique in athletes. eighteen athletes involved in competitive sports at different levels, who suffered from chronic lateral ankle instability, underwent Broström-Gould ligamentoplasty between 2000 and 2005. The results of the surgery were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scale. the results at 10-15 years of follow-up were excellent in 94.5% of these cases and good in the remaining 5.5%. An increase of 31.2 points in the AOFAS scale score was recorded at follow-up (with the score rising to 98.8, from 67.6 preoperatively). All the athletes returned to their respective sports at the same level as prior to the surgery. Imaging at long-term follow-up showed no signs of arthritic degeneration. the results of this study show that the Broström-Gould technique is an effective procedure for the treatment of chronic lateral ankle instability in the athlete, giving excellent long-term results. therapeutic case series, level IV.

Anterior shoulder stabilization by Bristow-Latarjet procedure in athletes: return-to-sport and functional outcomes at minimum 2-year follow-up.

The aim of this study was to assess return-to-sport outcomes following the Latarjet-Bristow procedure. This retrospective study included all athletes <50years old, who underwent a Latarjet-Bristow procedure for anterior shoulder instability in 2009-2012. Main criteria assessments were the number of athletes returning to any sport and the number returning to the same sport at their preinjury level. The main follow-up was 46.8±9.7months. Forty-seven patients were analyzed, 46 men/1 women, mean age 27.9±7.9years. Eighteen patients practiced competitive sports and 29 recreational sports. None of them were professional athletes. One hundred percent returned to sports after a mean 6.3±4.3months. Thirty/47 (63.8%) patients returned to the same sport at the same level at least and 10/47 (21.3%) patients changed sport because of their shoulder. Compared to patients who returned to the same sport at the same level, patients who changed sports or returned to a lower level had practiced overhead or forced overhead sports [OR=4.7 (1.3-16.9), p=0.02] before surgery, experienced avoidance behavior at the final follow-up (p=0.002), apprehension (p=0.00001) and had a worse Western Ontario Shoulder Instability Index score and sub-items (p=0.003) except for daily activities (p=0.21). At the final follow-up, 45/47 (95.7%) patients were still practicing a sport. All the patients returned to sports, most to their preinjury sport at the same level. Patients who practiced an overhead sport were more likely to play at a lower level or to change sport postoperatively. IV, retrospective study-Case series with no comparison group.

Return to Play After Open Bankart Repair: A Systematic Review.

Background:Results of open Bankart repair have been well reported. However, less information is available outlining the timetable for return to play (RTP) in athletes after this procedure.Purpose:To review the current literature regarding (1) the timetable recommended for athletes to RTP after an open Bankart repair and (2) the objective criteria on which the decision to allow an athlete to RTP is based.Study Design:Systematic review; Level of evidence, 4.Methods:A comprehensive literature search was conducted of all relevant English-language articles using the electronic databases OVID and PubMed between the years 1947 and 2012 to identify open Bankart repair. Two reviewers screened articles for eligibility based on the following criteria: (1) an open Bankart repair, (2) a minimum follow-up of at least 8 months, (3) any report that described the procedure in athletes, and (4) any report that described the time for an athlete to RTP. All relevant data were collected and analyzed with regard to number of patients; mean follow-up; Rowe, Constant, and American Shoulder and Elbow (ASES) scores; redislocation rate; and return-to-sport timing.Results:In all, 559 relevant citations were identified, of which 29 articles met the inclusion criteria. The mean follow-up was 51.7 months (range, 8-162 months), and the mean age was 25.9 years (range, 21-31 years). The average Rowe score for all studies was 86.9 (range, 63-90). The average redislocation rate was 5.3%. Twenty-six of 29 studies cited a specific timetable for unrestricted RTP, with an average of 23.2 weeks (range, 12-36 weeks). Only 38% of authors reported sport-specific criteria for return to competition, with the majority allowing return to noncontact sports at 12 to 16 weeks, and the resumption of throwing/contact sports by 24 weeks. Three reports described specific functional parameters for RTP.Conclusion:The current review summarized return-to-play guidelines for athletic competition after open Bankart repair. These data may provide general guidelines to aid surgeons when determining the appropriate timetable to allow an athlete to return to unrestricted competition.

Evaluation and Management of Arrhythmia in the Athletic Patient

Athletes may present with palpitations, syncope, or arrest resulting in the diagnosis of arrhythmia, or screening may result in diagnosis of conditions with predisposition to arrhythmia. This chapter focuses on 3 common arrhythmic conditions in athletes—atrial fibrillation, premature ventricular contractions (PVCs), and the athlete with an implanted device.(1) Atrial fibrillation: most studies show that atrial fibrillation is more common in competitive athletes, particularly those participating in long-term endurance sports. Postulated mechanisms include morphologic changes such as atrial dilatation, autonomic changes such as increased vagal tone, or inflammatory changes due to sports participation. Treatment options include long-term antiarrhythmic agents, “pill in the pocket” medications, or radiofrequency ablation, a highly successful procedure in athletes.(2) Premature ventricular contractions: data conflict on whether the incidence of PVCs is increased in highly trained individuals. Very frequent PVCs in athletes, however, can be a manifestation of underlying heart disease, and athletes presenting with PVCs should undergo evaluation. In the absence of underlying heart disease, PVCs do not carry a poor prognosis, and US guidelines do not recommend restriction from sports.(3) Implanted devices: the safety of sports for the athlete with an implanted device is unknown, and current guidelines recommend against participation in vigorous competitive sports, based on postulated risks including failure to defibrillate and risk of injury. Many athletes with defibrillators and pacemakers do participate in sports. Ongoing research will better delineate the risks of sports for the athlete with an implanted device.

Interventional Spine Procedures in Athletes

Back pain is common in athletes and a source of missed time from practice and competition. Pain generators include muscle (strain), ligament (myofascial sprain and strain), intervertebral disc (herniation and degeneration), nerve (radiculopathy), joint (facet and sacroiliac (SI) joint), and bones (pars interarticularis defect). The goal of treatment of an athlete with back pain is to relieve symptoms and facilitate safe but rapid return to play with no change in performance. Initial conservative treatment includes relative rest, anti-inflammatory medications, and physical therapy. The use of interventional spine procedures in athletes with back pain has gained popularity as a nonoperative treatment option. Although there is lack of high-quality evidence of these procedures specifically in athletes, this article will discuss the utility of selective nerve root blocks, epidural steroid injections, intradiscal injections, pars interarticularis injection, facet joint interventions (intraarticular injection, medial branch block, and radiofrequency neurotomy), and SI joint interventions (intraarticular injection and radiofrequency neurotomy).

Percutaneous nucleotomy in elite athletes.

Percutaneous nucleotomy in elite athletes is considered a minimally invasive treatment of lumbar disc herniation. However, long-term effectiveness has not been established by careful follow-up studies. This article evaluates the outcome of percutaneous nucleotomy in elite athletes who have undergone the procedure. Thirty elite athletes with lumbar disc herniation who underwent percutaneous nucleotomy and had been followed for at least 2 years were compared with a matched group of 42 nonathletes. The outcome in athletes was worse than in nonathletes. Early return to vigorous sports activity in less than 3 months correlated with increased symptoms. Similarly, more extensive resection of disc material was associated with an unexpected rapid worsening of the outcome and the lower rate of return to preoperative sports. Patient selection and postoperative management of athletes and nonathletes undergoing percutaneous nucleotomy should be the same, and the procedure in athletes is probably not worthwhile if they do not obey postoperative management such as the timing of return to sports activity.

Inferior capsular shift procedure in athletes with multidirectional instability based on isolated capsular and ligamentous redundancy.

Twenty-five athletes (26 shoulders) who underwent an inferior capsular shift procedure for multidirectional glenohumeral instability based on isolated capsular and ligamentous redundancy were evaluated at a median of 54 months (range, 25 to 113) after the operation. Twenty-one athletes (84%) returned to their preinjury activity level at a median of 5 months after surgery. Of 21 athletes involved in sports using overhead motions, 16 (76%) returned to their previous sport after the operation, and 12 (57%) were still active in this sport at the preinjury level at follow-up. According to the Rowe score, 23 shoulders (88%) were excellent or good. The University of California at Los Angeles score for 24 shoulders (92%) was excellent or good. The operations on two shoulders (8%) failed. One patient had a spontaneous redislocation, and one had recurrent subluxations. Nine contralateral shoulders had a history of significant instability; four of these had undergone Bankart repair. We concluded that athletes who have multidirectional instability based on isolated capsular and ligamentous redundancy can be successfully treated by an inferior capsular shift preserving the subscapularis tendon insertion. We found a high rate of return to demanding upper extremity sports in our patients, range of motion was restored in the majority of shoulders, and the failure rate after a median of 54 months was acceptable.

A study of modified Bristow procedure in athletes

A study of modified Bristow procedure in athletes

The Mumford procedure in athletes. An objective analysis of function.

No report in the English literature exists on objective muscle testing following the Mumford procedure (distal clavicular resection). Twenty-three athletes, including six at the professional level, were evaluated an average 3.7 years after the Mumford procedure was performed for degenerative changes after a Grade I or Grade II dislocation. All athletes were evaluated with an in depth questionnaire, physical examination, and radiographic study. Seventeen performed Cybex testing of both shoulders. All but one were satisfied with the surgery. Sixteen returned to their same level of sports activity, including five of the six professional athletes. The most common complaint of all those not achieving the previous level of sports was the inability to achieve their previous maximum bench press strength. All athletes demonstrated full motion; five exhibited painless crepitation at the acromioclavicular joint. Ten of the twenty-three exhibited increased horizontal clavicular motion. Radiographs demonstrated an average of 1.9 cm of bone resection, with varying amounts of ossification present between the remaining clavicle and acromion in eight athletes. The involved limb performed significantly more work than the sound limb in flexion (P = 0.0133) and internal rotation (P = 0.0575) at 300 deg/sec. The involved limb performed significantly more repetitions at 300 deg/sec than the sound limb in the extension plane (P = 0.0373). The sound limb was significantly stronger during extension (P = 0.0759) and flexion (P = 0.0063) at 60 deg/sec compared to the involved limb. The sound limb performed significantly more total repetitions at 300 deg/sec in the abduction-abduction plane than the involved limb (P = 0.0843).(ABSTRACT TRUNCATED AT 250 WORDS)