Purpose
To identify predictors of patient-reported outcomes and revision surgery risk after surgical management of shoulder instability in a cohort of top level collegiate American football players.
Methods
Top level collegiate American football players undergoing surgical management of shoulder instability between 2017 and 2021 at a single institution were included. Demographics, imaging data, surgical details, and postoperative outcomes were collected. The primary outcome was revision surgery, while the secondary outcome was Western Ontario Shoulder Instability Index (WOSI) score. Hill-Sachs lesions and glenoid bone loss were evaluated on MRI. Associations between outcomes and demographics, imaging, and surgical details were assessed. Categorical and continuous variables were analyzed using binary logistic regression and linear regression models, respectively, while Mann-Whitney U test or Kruskal-Wallis test were used for non-normally distributed variables.
Results
In total, 17 shoulders of 16 male athletes were included, with a mean age of 19.8 ±1.1 years (range 18-22) and mean follow-up of 1.9 ±0.9 years (range 1-4.9). All patients underwent arthroscopic labrum repair without remplissage, and two shoulders (12%) underwent concomitant open Bankart repair. One shoulder underwent anterior repair without posterior repair, 8 underwent posterior repair without anterior repair, and 8 underwent anterior and posterior repairs. Superior labrum repairs were performed in 8 shoulders. A mean of 6.2 anchors were used in each shoulder, and every shoulder had suture anchors placed in at least 2 quadrants. Hill-Sachs lesions were seen in 7 shoulders (41%). Fourteen (82%) shoulders had no glenoid bone loss, 1 (6%) had < 15% of glenoid bone loss, and 2 (12%) had > 15% of glenoid bone loss. Two shoulders (12%) experienced recurrent instability requiring revision surgery. Significant differences were found in postoperative WOSI scores between patients with recurrent instability and those without recurrent instability (33% ±11.5 vs 6% ±5.3, p=0.02). Additionally, almost three times higher postoperative WOSI scores were found in patients with Hill-Sachs lesions compared to patients without Hill-Sachs lesions (16% ±13.5 vs 6% ±5.8, p=0.03). No significant predictors of revision surgery were found.
Conclusion
In top level collegiate American football players with shoulder instability, a low recurrence rate (12%) was seen despite no use of remplissage or bone block procedures, and a low use of open Bankart repair, perhaps related to a mean of 6 anchors per shoulder and all patients undergoing anchor fixation in more than one quadrant. The presence of Hill-Sachs lesions and recurrent shoulder instability yielded inferior postoperative outcomes. These findings may guide surgeons towards more aggressive surgical management in the setting of Hill-Sachs lesions in this high-risk population.