Anterior Shoulder Instability Part III—Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up—An International Consensus Statement

Matache, Bogdan A.; Hurley, Eoghan T.; Wong, Ivan; Itoi, Eiji; Strauss, Eric J.; Delaney, Ruth A.; Neyton, Lionel; Athwal, George S.; Pauzenberger, Leo; Mullett, Hannan; Jazrawi, Laith M.; Alaia, Michael J.; Arciero, Robert A.; Bedi, Asheesh; Brophy, Robert H.; Calvo, Emílio; Campbell, Kirk A.; Carter, Cordelia W.; Cassidy, J. Tristan; Ciccotti, Michael G.; Cole, Brian J.; Cordasco, Frank A.; Edwards, Sara; Erickson, Brandon J.; Favard, Luc; Frank, Rachel M.; Funk, Lennard; Garrigues, Grant E.; Giacomo, Giovanni Di; Gonzalez-Lomas, Guillem; Heuberer, Philipp R.; Imhoff, Andreas B.; Kelly, John D.; Khan, Moin; Krych, Aaron J.; Kuhn, John E.; Kwon, Young Mi; Lädermann, Alexandre; Levine, William N.; Fat, Darren Lim; Mazzocca, Augustus D.; MacDonald, Peter B.; McCarty, Eric C.; Meislin, Robert J.; Millett, Peter J.; Molony, Diarmuid C.; Moran, Cathal J.; Moroder, Philipp; Moya, Daniel; O’Shea, Kieran; Owens, Brett D.; Provencher, Matthew T.; Rhee, Yong Girl; Rodeo, Scott A.; Rokito, Andrew S.; Rosso, Claudio; Scheibel, Markus; Verma, Nikhil N.; Virk, Mandeep S.; Walch, Gilles; Warren, Russell F.; Waterman, Brian R.; Whelan, Daniel B.; Zuckerman, Joseph D.

doi:10.1016/j.arthro.2021.07.019

Cited by 44 publications

(21 citation statements)

References 35 publications

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“… 5–7 Postoperative rehabilitation therapy is essential for restoring shoulder mobility, strength and protecting the surgical repair. 5 , 6 , 8 As such, rehabilitation following an ABR has been a topic of investigation in recent years. 5 , 6 , 9 Currently, there is a consensus guideline attempt by the American Society of Shoulder and Elbow Therapists (ASSET) and several rehabilitation protocols available in the literature.…”

Section: Rehabilitationmentioning

confidence: 99%

“…However, there is still a lack of a validated standard of care protocol. 5 , 6 , 8–10 Therefore, wide variability exists across the professional literature concerning the key elements of rehabilitation after an ABR. 5 , 6 , 9 …”

Section: Rehabilitationmentioning

confidence: 99%

“…A 2022 international consensus found strong agreement in the restoration of strength, restoration of range of motion, free apprehension, pain-free, sport-specific skills, and restoration of proprioception. 8 However, in a recent systematic review, Ciccotti et al evaluated the criteria for return to sport (RTS) after surgical stabilization of anterior shoulder instability. 15 The authors included 58 studies describing at least 1 criterion used by researchers to allow return to sports.…”

Section: Criteria For Return To Sportsmentioning

confidence: 99%

“…Regarding strength, although this is a difficult parameter to measure objectively in the office, we believe it should be recorded and taken into account when evaluating the possibility of returning to sport. 8 In the case of competitive athletes who usually go to the gym as a regular part of their physical training, we take into account the loads they lifted before the injury and we use that information as a guide during the evolution of their recovery. In competitive sports where there is a significant demand for strength and power to the shoulder, such as collision and forced overhead sports, we let patients to compete again when they are able to lift > 80% of the weight they lifted before the injury.…”

Section: Criteria For Return To Sportsmentioning

confidence: 99%

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Factors That Influence the Return to Sport After Arthroscopic Bankart Repair for Glenohumeral Instability

Rossi

Pasqualini

Tanoira

et al. 2022

OAJSM

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Numerous studies have reported high rates of return to sports following arthroscopic Bankart repair (ABR) However, there is enormous controversy regarding the optimal management of these patients in the postoperative period. Controversy issues include rehabilitation, criteria for returning to sports, and the specific management of each athlete according to the sport they practice. Even though there are several rehabilitation protocols published in the literature, wide variability exists concerning the key elements of rehabilitation after an ABR. Regarding criteria for return to sports, there is a wide variation across the different published studies. The type of sports has been shown to affect an athlete’s decision to return to sports. Nevertheless, most research is evaluated by classifications that cluster different sports into categories that may have other influences in return to sports when analyzed separately. Finally, in addition to physical readiness, the athlete’s psychological state is crucial for returning to sports. However, the contribution of psychological readiness to an athlete’s return to sports after shoulder instability surgery remains uncertain and unexplored.

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Section: Rehabilitationmentioning

confidence: 99%

Section: Rehabilitationmentioning

confidence: 99%

Section: Criteria For Return To Sportsmentioning

confidence: 99%

Section: Criteria For Return To Sportsmentioning

confidence: 99%

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Factors That Influence the Return to Sport After Arthroscopic Bankart Repair for Glenohumeral Instability

Rossi

Pasqualini

Tanoira

et al. 2022

OAJSM

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“…8 The complexity of the anatomic shoulder stabilizers results in a variety of pathologies in patients with anterior shoulder instability. 3,10,13,14,20,25 Davey et al 5,6 previously reported that the average collision athlete with anterior shoulder instability experiences a multitude of pathologies secondary to recurrent dislocations displayed on preoperative imaging before surgical stabilization, with bony Bankart and Hill-Sachs lesions being the most common. In addition, the humeral avulsion glenohumeral ligament (HAGL) lesion has been shown to occur in up to 10% of cases of recurrent anterior shoulder instability.…”

mentioning

confidence: 99%

Clinical Outcomes in Patients With Humeral Avulsion Glenohumeral Ligament Lesions in the Setting of Anterior Shoulder Instability: A Retrospective Comparative Study

et al. 2022

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Background: Humeral avulsion glenohumeral ligament (HAGL) lesions are often underreported but have been shown to occur in up to 10% of cases of anterior shoulder instability. Purpose: To compare clinical outcomes and recurrence rates of patients with HAGL lesions undergoing open stabilization for anterior shoulder instability versus a pair-matched control. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of all patients who underwent both arthroscopic and open stabilization procedures with a minimum 24-month follow-up was performed. Patients with HAGL lesions were pair-matched in a 1:6 ratio for age, sex, sport, level of preoperative play, and follow-up length with those without HAGL lesions who underwent arthroscopic Bankart repair alone. Return to play (RTP), the level of return, and the timing of return were assessed. In addition, recurrence, visual analog scale for pain (VAS), Subjective Shoulder Value (SSV), Rowe score, satisfaction, and whether they would undergo the same surgery again were compared. Results: A total of 15 patients with HAGL lesions who underwent shoulder stabilization procedures were included, with a mean age of 21.5 ± 4.1 years and mean follow-up of 53.5 ± 17.4 months, and were pair-matched to 90 patients without HAGL lesions. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SSV, satisfaction) used between the 2 groups (1.6 vs 1.7, P = .86; 83.4 vs 88.0, P = .06; 85.7 vs 87.2, P = .76; and 86.7% vs 94.5%, P = .26, respectively). In addition, there were no significant differences in terms of overall rates, levels, and timing of RTP between the 2 groups (93.3% vs 90.0%, P > .99; 80.0% vs 78.9%, P > .99; and 5.3 ± 2.2 vs 5.9 ± 2.9 months, P = .45, respectively). There was no significant difference in the rates of apprehension, subluxation, and recurrent instability between the HAGL and pair-matched control groups (26.7% vs 26.7%, P > .99; 6.7% vs 3.3%, P = .47; and 13.3% vs 6.7% months, P = .32, respectively). Conclusion: Patients with anterior shoulder instability undergoing surgical stabilization with open HAGL repair demonstrate excellent functional outcomes and high rates of RTP, with low rates of recurrence in the medium term compared with a control group without HAGL lesions who underwent arthroscopic Bankart repair alone.

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Glenohumeral morphological predictors of recurrent shoulder instability following arthroscopic Bankart repair

Hurley,

O'Grady,

Davey

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to evaluate glenohumeral morphological features on a magnetic resonance arthrogram (MRA) to determine risk factors for recurrence of anterior shoulder instability following arthroscopic Bankart repair (ABR).MethodsA retrospective review of patients who underwent ABR between 2012 and 2017 was performed to identify patients who had recurrence of instability following stabilisation (Group 1). These were pair‐matched in a 2:1 ratio for age, gender and sport with a control (Group 2) who underwent ABR without recurrence. Preoperative MRAs were evaluated for risk factors for recurrence, with glenoid bone loss and Hill–Sachs lesions also measured. Multilinear and multilogistic regression models were used to evaluate factors affecting recurrence.ResultsOverall, 72 patients were included in this study, including 48 patients without recurrence and 24 patients with recurrent instability. There was a significant difference between the two groups in mean glenoid bone loss (Group 1: 7.3% vs. Group 2: 5.7%, p < 0.0001) and the rate of off‐track Hill–Sachs lesions (Group 1: 20.8% vs. Group 2: 0%, p = 0.0003). Of the variables analysed in logistic regression, increased glenoid anteversion (p = 0.02), acromioclavicular (AC) degeneration (p = 0.03) and increased Hill–Sachs width were associated with increased risk of failure. Increased chondral version (p = 0.01) and humeral head diameter in the anteriorposterior view were found to be protective and associated with a greater likelihood of success.ConclusionGlenoid anteversion was a risk factor for recurrent instability, whereas increased chondral version and humeral head diameter were associated with higher rates of success following ABR. Glenoid bone loss, presence of an off‐track Hill–Sachs lesion, increased Hill–Sachs width and AC degeneration were also associated with failure. These findings should be used by surgeons to stratify risk for recurrence following ABR.Level of EvidenceLevel III.

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Anterior Shoulder Instability Part III—Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up—An International Consensus Statement

Cited by 44 publications

References 35 publications

Factors That Influence the Return to Sport After Arthroscopic Bankart Repair for Glenohumeral Instability

Factors That Influence the Return to Sport After Arthroscopic Bankart Repair for Glenohumeral Instability

Clinical Outcomes in Patients With Humeral Avulsion Glenohumeral Ligament Lesions in the Setting of Anterior Shoulder Instability: A Retrospective Comparative Study

Glenohumeral morphological predictors of recurrent shoulder instability following arthroscopic Bankart repair

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