Shoulder Instability In Athletes Research Articles

Open Bristow Versus Open Latarjet for Anterior Shoulder Instability in Rugby Players: Radiological and Clinical Outcomes.

Background:Coracoid transfer is a reliable method for managing anterior shoulder instability in athletes who play contact sports; however, differences between the Bristow and Latarjet procedures are unclear.Purpose:To compare clinical outcomes and rates of bone union and bone resorption of the coracoid process between the open Bristow and open Latarjet procedures in rugby players.Study Design:Cohort study; Level of evidence, 3.Methods:Rugby players who underwent an open Bristow or an open Latarjet procedure were retrospectively reviewed for anterior shoulder instability, and 66 shoulders in the Bristow group and 35 in the Latarjet group were included. Graft union and resorption were evaluated using computed tomography at 3 months to 1 year postoperatively. Patient-reported outcome measures (American Shoulder and Elbow Surgeons score, Rowe score, and satisfaction rate) were obtained at a mean follow-up of 74 months (range, 45-160 months) for Bristow and 64 months (range, 50-76 months) for Latarjet procedures. Recurrence and the rate of return to play (RTP), frequency of pain after RTP, and retirement rate after RTP were also assessed.Results:In 97.1% of the Latarjet procedure cases, bone union of the coracoid was achieved at 3 months postoperatively; however, bone union was achieved in only 72.7% of the Bristow procedure cases at 6 months postoperatively. Bone resorption of the coracoid process occurred in 6.1% of shoulders after the Bristow procedure, whereas 100% of shoulders showed bone resorption after the Latarjet procedure. No statistical differences were found in outcome scores between the 2 procedures. Subluxation and persistent pain after returning to sports were identified at a significantly higher rate in the Latarjet group (5 shoulders [14%] and 9 shoulders [26%], respectively) than in the Bristow group (2 shoulders [3%] and 2 shoulders [3%]) (P = .0471 and P = .001, respectively).Conclusion:The Latarjet procedure had an advantage in the early and high rate of bone union but was at a disadvantage in bone resorption compared with the Bristow procedure. Subluxation and pain after returning to sports were more frequent in patients who underwent the open Latarjet procedure than in those who underwent the open Bristow procedure.

Team Approach: Treatment of Shoulder Instability in Athletes.

Shoulder instability is a complex problem with a high rate of recurrence in athletes. Treatment of a first-time subluxation or dislocation event is controversial and depends on patient-specific factors as well as the identified pathology. Athletic trainers and physical therapists are an integral part of the treatment team of an in-season athlete who has experienced a shoulder instability event. Through comprehensive physiological assessments, these providers can effectively suggest modifications to the patient's training regimen as well as an appropriate rehabilitation program. Surgical intervention for shoulder stabilization should use an individualized approach for technique and timing. A team-based approach is necessary to optimize the care of this high-demand, high-risk population.

Arthroscopic Bankart repair for first time versus recurrent anterior shoulder instability in athletes- comparative Study

Background: Following an initial traumatic anterior shoulder dislocation, the incidence of recurrent instability ranges from 14% to 100%. The risk of recurrent dislocations is influenced by the age at the time of initial dislocation. The aim of the present study was to evaluate the results of arthroscopic bankart repair of acute anterior shoulder dislocation for first time in athletes and comparison the results with delayed arthroscopic bankart repair Patient and methods: The present study included 40 patients complaining of anterior shoulder dislocation, 20 patients of them were with first time anterior shoulder dislocation and 20 patients with recurrent dislocation. All patients underwent Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability. The constant shoulder score was used for assess the outcomes Results: There was statistically significant difference between pre and post-operative outcome in first time dislocation patients. There was statistically significant difference between pre and post-operative outcome in recurrent dislocation patients. There was no statistically significant difference according to post-operative outcomes between in first time and recurrent dislocation patients. Conclusion: there were no differences in outcomes and constant shoulder score among patients undergoing surgery after the primary dislocation when compared with those undergoing surgery after recurrent shoulder dislocation.

Outcomes After Arthroscopic Anterior Shoulder Stabilization in Professional Handball Players

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.

Postoperative Rehabilitation and Return to Play Criteria After Anterior Shoulder Stabilization Procedures

Anterior shoulder stabilization surgery is the preferred method to treat shoulder instability in athletes; however, a variety of surgical techniques exist. The rehabilitation specialist needs to have a basic understanding of each procedure to properly protect healing structures while restoring range of motion, strength, and functional abilities. Few evidence-based guidelines exist for rehabilitation after anterior shoulder stabilization, and those that are available are specific to the standard arthroscopic approach. Further, even less guidance is available for the later stages of rehabilitation and return to sports preparation and decision making. In this review article, rehabilitation considerations and alterations for variations of anterior shoulder stabilization surgery are presented. The importance of individualizing late-stage rehabilitation and incorporating core and lower extremity exercises as appropriate is also discussed. Lastly, rationale for criteria-based return to sports assessments to aid clinical decision making is presented.

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.

Management and Outcomes of In-Season Anterior Shoulder Instability in Athletes.

» Anterior shoulder dislocation is a common problem in athletes and has serious implications due to the rate of injury recurrence and the resulting extended time out of play.» There are a variety of management options that address shoulder instability in an in-season athlete, and the decision-making approach should be individualized to the athlete.» Although nonoperative management and return to play in the same season may be a suitable option for a subset of athletes who wish to return to play as soon as possible (during a recruiting season, for an upcoming Combine, or if they are in the last season of their career), given the high risk of recurrence, we recommend that immediate surgical intervention should be considered to decrease the risk of further damage to the glenohumeral joint.» Arthroscopic stabilization currently is the most commonly performed intervention for athletes with anterior shoulder instability in the United States, but open repair remains an excellent option for high-risk patients.» In collision athletes with subcritical glenoid bone loss between 13.5% and 25%, early open anterior capsulolabral reconstruction or a Latarjet procedure is recommended. If glenoid bone loss exceeds 25%, the Latarjet or another glenoid osseous augmentation procedure should be performed to reduce the risk of recurrent anterior instability.

Posterior Shoulder Instability in Athletes.

Posterior instability represents up to 10% of all cases of shoulder instability1. In athletes, posterior instability can result from a single traumatic injury, repetitive microtrauma, or, rarely, atraumatic instability. The demands on the athlete’s shoulder, especially in contact or overhead throwing sports, can be dramatic, and, as a result, the managing orthopaedic surgeon must understand the complexities of such an injury complex. Participation in contact sports may result in an increased risk for the development of traumatic posterior instability. In overhead athletes, posterior instability can result from repetitive microtrauma sustained from an early age, which can be further exacerbated with the increase in year-round play. ### Static Stabilizers The static stabilizers of the glenohumeral joint include the glenoid and the humeral head, the capsulolabral complex, the articular surface, and the glenohumeral ligaments. Anatomic alterations of the retroversion of the osseous and chondrolabral portions of the glenoid have been shown to be associated with posterior shoulder instability2. Cadaveric studies of …

Evaluation of functional outcomes and complications following modified Latarjet reconstruction in athletes with anterior shoulder instability.

The optimal management of anterior shoulder instability in athletes continues to be a challenge. The present study aimed to evaluate the functional outcomes of athletes with anterior shoulder instability following modified Latarjet reconstruction through assessing the timing of return to sport and complications. Retrospective assessment was performed of athletes (n = 56) who presented with recurrent anterior shoulder instability and were treated with modified congruent arc Latarjet reconstruction over a 1-year period. Rugby union was the predominant sport performed. Pre-operative instability severity index scores were assessed. Postoperative complications were recorded as was the time taken for the athlete to return to sport. Arthroscopic evaluation revealed that 86% of patients had associated bony lesions affecting the glenohumeral joint. The overall complication rate relating to the Latarjet reconstruction was 7%. No episodes of recurrent shoulder instability were noted. Of the patients, 89% returned to competitive sport at the same level as that prior to surgery. The mean time post surgery to returning to full training was 3.2 months. The modified congruent arc Latarjet procedure facilitates early rehabilitation and return to sport. These results support our systematic management protocol of performing modified Latarjet surgery in contact sport athletes with recurrent anterior instability.

スポーツ選手に対する鏡視下 Bankart 修復術の臨床成績：スポーツ種目別の比較

スポーツ選手に対する鏡視下 Bankart 修復術の臨床成績：スポーツ種目別の比較

Iliac crest allograft glenoid reconstruction for recurrent anterior shoulder instability in athletes: Surgical technique and results.

Performing a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of the iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>25% of glenoid diameter). All athletes with recurrent anterior shoulder instability and a large glenoid defect that underwent open anterior shoulder stabilization and glenoid reconstruction with the iliac crest allograft were followed over a 4-year period. Preoperatively, a detailed history and physical exam were obtained along with standard radiographs and magnetic resonance imaging of the affected shoulder. All patients also completed the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) evaluation forms preoperatively. A computed tomography scan was obtained postoperatively to assess osseous union of the graft and the patient again went through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI) forms. 10 patients (9 males, 1 female) were followed for an average of 16 months (4–36 months) and had a mean age of 24.4 years. All patients exhibited a negative apprehension/relocation test and full shoulder strength at final follow-up. Eight of 10 patients had achieved osseous union at 6 months (80.0%). ASES scores improved from 64.3 to 97.8, and SST scores improved from 66.7 to 100. Average postoperative WOSI scores were 93.8%. The use of the iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency.

Paper 32: Posterior Traumatic Shoulder Instability in Athletes

The posterior shoulder instability is not so frequent but often as a part of the multidirectional instability. In these cases conservative treatment provides good results. In cases of trauma associated with posterior labral lesion, isolated posterior instability can occur, and the surgical treatment may be necessary. Evaluate the results of arthroscopic treatment for traumatic posterior shoulder instability. 21 shoulders/20 patients with traumatic posterior instability of the shoulder were treated arthroscopically. The mean age was 29.38 years (20-53), two patients were females and 18 males. All patients were involved in sports activities. The main complaint was the sensation of pain and giving way of the shoulder during sports activity. All patients had posterior labram injuries confirmed by MRI. The surgery was performed after failure of conservative treatment for three months. The patients underwent arthroscopic treatment on beach chair. The rehabilitation program consisted of postoperative immobilization for 3 weeks in sling in neutral rotation followed by physiotherapy. The return to sport was allowed after 5 months. We used an average of 2.76 anchors (2-4) for repair. The average follow-up was 28.47 months (12-70). There was improvement in symptoms of pain and feeling of instability in all patients. We found limited external rotation of 5 degrees in two patients, and 10 degrees in two other patients. One of the patient (4.76%) with 10 degrees of external rotation defict presented light sports limitations (Rowe Score-90). All the others patients(95.24%) returned to the sport without limitations. The arthroscopic treatment for traumatic posterior shoulder instability offers satisfactory results in the majority of cases (95.24%), with improvement of symptoms and allowing the return to activities. The limitation of external rotation (less than 10 degress) does not cause significant functional activities deficits.

Management of Mid-season Traumatic Anterior Shoulder Instability in Athletes

Shoulder dislocation and subluxation injuries are common in young athletes and most frequently occur during the competitive season. Controversy exists regarding optimal treatment of an athlete with an in-season shoulder dislocation, and limited data are available to guide treatment. Rehabilitation may facilitate return to sport within 3 weeks, but return is complicated by a moderate risk of recurrence. Bracing may reduce the risk of recurrence, but it restricts motion and may not be tolerated in patients who must complete certain sport-specific tasks such as throwing. Surgical management of shoulder dislocation or subluxation with arthroscopic or open Bankart repair reduces the rate of recurrence; however, the athlete is unable to participate in sport for the remainder of the competitive season. When selecting a management option, the clinician must consider the natural history of shoulder instability, pathologic changes noted on examination and imaging, sport- and position-specific demands, duration of treatment, and the athlete's motivation.

Shoulder Instability in Athletes

Define shoulder instability and identify the most common causes of shoulder instability in athletes. Shoulder instability encompasses a wide spectrum, from complete dislocations that require manual reduction to microinstability in throwers. When we looked prospectively at West Point cadets, we found that 80% of instability events were subluxations (no manual reduction performed).1 We found that even first-time traumatic subluxation events could cause Bankart lesions (transient luxations)2 similar to complete dislocations.3 Therefore, we recommend a high index of suspicion for subluxations and early magnetic resonance imaging in athletes. Shoulder instability is common in athletes, and the incidence increases with the amount of player contact. Therefore, the highest rates have been reported in the collision sports: football, hockey, rugby, and wrestling.

New developments in magnetic resonance imaging techniques for shoulder instability in athletes

Magnetic resonance (MR) imaging can be a very useful tool in the evaluation of instability in the athlete's shoulder. Technical options of MR imaging, such as arthrography, higher power magnets, and shoulder positioning, have enhanced MR evaluation of the shoulder. This update discusses the application of new MR techniques to a variety of shoulder instability patterns, including anterior instability, posterior instability, and atraumatic multidirectional instability. Specific applications of MR imaging in the postoperative patient is discussed. Finally, we describe the future directions of MR imaging in the setting of shoulder instability.

Arthroscopic Treatment of Traumatic Posterior Shoulder Instability in Athletes

Background Unidirectional traumatic posterior shoulder instability is a specific diagnosis that differs from the more common posteroinferior or multidirectional instabilities. The treatment usually requires a surgical procedure. Methods We treated 21 shoulders in 20 patients. The average age was 29.38 years (range 20 years to 53 years). All patients were involved in recreational sports. The mean follow-up was 28 months (range 12 months to 70 months). Results The postoperative clinical evaluation was based on the Rowe score. Twenty patients were considered to demonstrate excellent results and one patient was considered to show a regular result. Twenty patients were able to return to recreational sports at the same level. One patient returned to sport at a lower level and required playing adaptations. Conclusion In our series of 21 shoulders, pain was the major symptom in 15 patients with posterior labral detachment after a traumatic event. By contrast to classic Bankart lesion, which usually results in instability, the posterior labral detachment produced pain as the major symptom in this series of patients.

Iliac Crest Allograft for Glenoid Deficiency in Recurrent Shoulder Instability in Athletes (SS-15)

Iliac Crest Allograft for Glenoid Deficiency in Recurrent Shoulder Instability in Athletes (SS-15)

Arthroscopic Treatment of Multidirectional Shoulder Instability in Athletes: A Retrospective Analysis of 2- to 5-Year Clinical Outcomes

Arthroscopic Treatment of Multidirectional Shoulder Instability in Athletes: A Retrospective Analysis of 2- to 5-Year Clinical Outcomes

Arthroscopic Treatment of Multidirectional Shoulder Instability in Athletes

Background There are few reports in the literature detailing the arthroscopic treatment of multidirectional instability of the shoulder. Hypothesis Arthroscopic management of symptomatic multidirectional instability in an athletic population can successfully return athletes to sports with a high rate of success as determined by patient-reported outcome measures. Study Design Case series; Level of evidence, 4. Methods Forty patients (43 shoulders) with multidirectional instability of the shoulder were treated via arthroscopic means and were evaluated at a mean of 33.5 months postoperatively. The mean patient age was 19.1 years (range, 14-39). There were 24 male patients and 16 female patients. Patients were evaluated with the American Shoulder and Elbow Surgeons and Western Ontario Shoulder Instability scoring systems. Stability, strength, and range of motion were also evaluated with patient-reported scales. Results The mean American Shoulder and Elbow Surgeons score postoperatively was 91.4 of 100 (range, 59.9-100). The mean Western Ontario Shoulder Instability postoperative percentage score was 91.1 of 100 (range, 72.9-100). Ninety-one percent of patients had full or satisfactory range of motion, 98% had normal or slightly decreased strength, and 86% were able to return to their sport with little or no limitation. Conclusion Arthroscopic methods can provide an effective treatment for symptomatic multidirectional instability in an athletic population.

Management of Anterior Shoulder Instability in Athletes

Management of Anterior Shoulder Instability in Athletes