ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #1813

 

Arthroscopic Soft Tissue Shoulder Stabilization with Augmentation in Elite Judo Athletes

Hiroshige Hamada, MD, Funabashi, Chiba JAPAN
Hiroyuki Sugaya, MD, Funabashi, Chiba JAPAN
Norimasa Takahashi, MD, Funabashi, Chiba JAPAN
Keisuke Matsuki, MD, PhD, Funabashi, Chiba JAPAN
Morihito Tokai, MD, Funabashi, Chiba JAPAN
Yusuke Ueda, MD, Funabashi, Chiba JAPAN
Shota Hoshika, MD, Funabashi, Chiba JAPAN
Yasutaka Takeuchi, MD, Funabashi, Chiba JAPAN

Funabashi Orthopaedic Hospital, Funabashi, Chiba, JAPAN

FDA Status Not Applicable

Summary

Arthroscopic soft tissue shoulder stabilization with augmentation for shoulder instability in Judo athletes demonstrated excellent outcomes in terms of recurrence rate and sports return.

Abstract

Introduction

Although Judo is a world-wide sport that is an Olympic event, there are a few studies on clinical outcomes after surgical shoulder stabilization. The purpose of this study was to assess the outcomes after arthroscopic soft tissue stabilization in competitive Judo athletes who underwent shoulder stabilization.

Methods

Between May 2004 and December 2015, 125 shoulders in 119 competitive Judo athletes underwent shoulder stabilization under the diagnosis of recurrent traumatic anterior shoulder instability in our institute. However, 3 patients did not demonstrate Bankart lesion due to excessive laxity and 1 patient underwent bone grafting due to severe bone loss, therefore these patients were excluded. Among the remaining 121 shoulders in 115 patients, 90 shoulders in 84 patients were followed for a minimum of 2 years. They consisted of 63 males (67 shoulders) and 21 females (23 shoulders) with a mean age of 18.5 years (range, 13-32), and average follow-up period was 5.6 years (range, 2-14). There were 10 postgraduate, 43 collegiate, 28 high school, and 9 junior high school athletes, including 9 athletes who participated in world class competitions. Fifty-three shoulders were lapel hand (Tsurite) and 37 shoulders were sleeve hand (Hikite). All patients underwent arthroscopic bankart repair (ABR) or bony bankart repair (ABBR) in the beach-chair position under general anesthesia using a minimum of four suture anchors. In addition, rotator interval closure (RIC) was added in the majority of cases as an augmentation and Hill-Sachs remplissage (HSR) was added in young selective patients. We retrospectively reviewed patient records and investigated the cause of first-time dislocation, time to start practice and full return to competition, and recurrence rate and subjective shoulder value (SSV).

Results

The most common cause of first-time dislocation was landing on one hand when they were thrown (46%). Among those, 15 shoulders underwent both RIC and HSR as augmentations. Only 4 shoulders underwent ABR/ABBR without augmentation. Regarding sports return, although 4 players retired from competition for social reason other than shoulder problem after the index surgery, the remaining 85 shoulders in 80 patients returned to competition. Among them, 79 shoulders in 74 patients returned to pre-injury level and 6 shoulders in 6 patients returned to the lower level. Mean time to complete return was 11 months (range, 5-36) after surgery. Average SSV at the final follow-up was 91.6 (range, 70-100). 3 suffered shoulder dislocation and 1 suffered subluxation after surgery during Judo competition or exercises (recurrence rate: 4.4%). Among these 4 failure cases, 1 patient underwent revision stabilization and 2 patients are still competing at a lower level without revision surgery and 1 patient retired after the failure.

Conclusion

Arthroscopic soft tissue shoulder stabilization for traumatic anterior shoulder instability in Judo athletes demonstrated excellent outcomes in terms of recurrence rate and sports return. We believe that addressing every intra articular pathology and the addition of augmentation such as RIC and HSR, in conjunction with ABR or ABBR with proper ligament tensioning are the keys for achieving excellent outcomes in this extremely high demand patient population.