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Outcomes Of Arthroscopic Shoulder Stabilization At The United States Naval Academy: 5-Year Follow-Up


Bobby Yow, MD
UNITED STATES

Outcomes Of Arthroscopic Shoulder Stabilization At The United States Naval Academy: 5-Year Follow-Up

Bobby Yow, MD, UNITED STATES Sean Wade, MD, UNITED STATES Benjamin Hoyt, MD, UNITED STATES Michael Bedrin, MD, UNITED STATES Jon F. Dickens, MD, UNITED STATES John-Paul Rue, MD, UNITED STATES Lance LeClere, MD, UNITED STATES

Walter Reed National Military Medical Center, Bethesda, MD, UNITED STATES

2021 Congress   ePoster Presentation     Not yet rated

 

Anatomic Location

Shoulder Glenohumeral

Diagnosis / Condition

Instability

Treatment / Technique

Arthroscopy

Patient Populations

Sport Specific Population

Anatomic Structure

Capsuloligamentous Complex Labrum

Sports Medicine

Epidemiology Outcome Studies

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Summary: Five year outcomes and risk factors for failure after arthroscopic anterior, posterior, and combined stabilization in a young military population from the United States Naval Academy.

Introduction

Shoulder instability remains a common cause of pain and dysfunction, particularly in young active individuals. While arthroscopic stabilization has demonstrated excellent success in glenohumeral instability, recurrence remains a significant concern. The purpose of this study was to describe the recurrence rates of arthroscopic stabilization to address anterior, posterior, and combined (anterior and posterior) glenohumeral instability at minimum five-year follow up in a young and active population at a single institution. Additionally, this study seeks to identify risk factors for recurrent instability.

Methods

We retrospectively reviewed 219 patients who underwent arthroscopic shoulder stabilization at a single facility performed by two fellowship trained sports surgeons between 1 January 2010 and 31 December 2015. Inclusion criteria was a minimum follow up of five years after index surgical repair. We collected patient demographics, date of initial injury or symptom onset, primary symptoms, athletic participation, prior instability events, surgical intervention and associated details, repair failure, revision procedures, and complications. Our primary outcome measures were failure and operative revision surgery. We considered failure as any recurrent shoulder instability events including subjective subluxation and dislocation, recurrence of pain consistent with instability, or functionally limiting apprehension. In total, we identified 169 patients who met inclusion criteria for this study.

Results

Isolated Anterior: 95 patients underwent repair for the anterior labrum only. Of these, 86% were male with median age 20.5 years (IQR 19.6-21.9) and mean ISIS score 4.0 +/- 1.2. Of the 95 patients, 16 (16.8%) failed initial repair at median 1.9 (IQR 0.9-4.5) years after surgery. The majority of failures (56.2%) occurred at greater than 2 years. Fourteen patients (88%) underwent revision surgery. Female sex was associated with greater risk of failure (OR 3.96, 95% CI 0.86-16.9, p=0.04). No other risk factors were identified for failure including ISI score, larger tear size, or age. ISI score also was not associated with increased anchor use (p=0.58).

Isolated Posterior: A total 29 patients underwent repair for the posterior labrum only. Of these, 97% were male with median age 21 (IQR 19-22) years. Five patients (17.2%) failed initial repair at median 4.0 (IQR 3.0-4.9) years after surgery, of whom all proceeded to undergo revision surgery. In total, 80% of failures occurred after 2 years. Based on the numbers available, we were unable to identify any specific risk factors for failure of posterior labral repair, to include sex, tear size, anchors used, and age at surgery.

Combined: 45 patients underwent repair for combined labral tears. Of these, 91% were male and median age was 21 (IQR 19-22) years. Five patients (11.1%) failed initial repair at median 2.2 (IQR 1.3-2.8) years after surgery, of whom four patients (80%) underwent revision surgery. In this group, 60% of failures occurred after 2 years. Patients who experienced failure of combined labral tears were younger (19.8 versus 21.9, p=0.03). Females also failed at a faster rate on survival analysis (p=0.002). Neither tear size nor number of anchors were associated with failure (p=0.99, p=0.96, respectively).

Conclusion

Recurrent glenohumeral instability after arthroscopic stabilization presents a significant concern for surgeons and patients. This study demonstrated failure rates of arthroscopic anterior, posterior, and combined stabilization to be lower than what has been previously reported in numerous studies, despite the young and active patients unique to this cohort.

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