Arthroscopic Posterior Labral Repair in Active-Duty Military Patients: A Reliable Solution for an At-Risk Population, Regardless of Anchor Type

Abstract

Background: Active-duty servicemembers are a population at risk for the development of posterior shoulder instability. While short-term outcomes after arthroscopic posterior labral repair for posterior shoulder instability are promising, there is a paucity of longer term follow-up data for this procedure. Purposes: The primary purpose was to report midterm outcomes after arthroscopic posterior labral repair in active-duty military patients for posterior shoulder instability without bone loss. The secondary purpose was to determine if outcomes varied between anchor types used. Study Design: Cohort study; Level of evidence, 3. Methods: Preoperative and postoperative outcomes, with a minimum 3-year follow-up, for a visual analog scale for pain, the Single Assessment Numeric Evaluation (SANE), the American Shoulder and Elbow Surgeons (ASES) score, and the Rowe score were collected and analyzed. A separate subgroup analysis was performed comparing the outcomes of patients who underwent repair with biocomposite anchors versus those who underwent repair with all-suture anchors. Results: A total of 73 patients with a mean follow-up of 82.55 ± 24.20 months met the inclusion criteria and were available for analysis. As a whole, the cohort demonstrated statistically and clinically significant improvements in outcome scores at final follow-up. Preoperative and postoperative range of motion did not vary significantly. While the difference in final outcome scores between the 2 anchor types did not reach statistical significance, a statistically significantly larger proportion of patients who underwent repair with all-suture anchors versus those who underwent repair with biocomposite anchors met the Patient Acceptable Symptom State for the SANE (97.14% vs 78.95%, respectively; P = .0180) and the ASES score (88.57% vs 68.42%, respectively; P = .0171). The proportion of patients who achieved the substantial clinical benefit or surpassed the minimal clinically important difference, however, did not vary by anchor type. Overall, 70 patients (95.89%) remained on active duty and were able to return to preinjury work and recreational activity levels. There were 3 patients (4.11%) who had recurrent posterior instability. Conclusion: This population of active-duty servicemembers undergoing posterior labral repair for posterior labral instability without bone loss demonstrated a statistically and clinically significant improvement in midterm outcomes, a low recurrence rate, and a rate of return to active duty of 95.89%, regardless of the anchor type used.

Establishing the Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State After Arthroscopic Posterior Labral Repair for Posterior Glenohumeral Instability

“…17,32 As such, soldiers represent a unique opportunity to study posterior instability, and several studies have reported outcomes after aPLR in military cohorts. Scanaliato et al 32 demonstrated significantly improved outcomes in a cohort of young military patients at midterm follow-up, with over 90% of patients returning to active-duty military service. Similar outcomes were noted by Hines et al, 17 who reported high rates of return to active duty and low reoperation rates in a cohort of active-duty service members at a mean of 4.5 years' follow-up.…”

“…Rather, posterior instability more often results from repetitive posterior subluxation, microtrauma, or ligamentous laxity with an insidious onset. 3,29,32 However, it is possible that patients who suffer an acute, traumatic injury may seek surgical treatment in a more timely manner compared with those whose instability is secondary to a degenerative mechanism. Additionally, the labral and capsular sequelae of chronic posterior instability may be less amenable to repair, and chronic instability has been associated with increased glenoid bone loss.…”

“…Outcome reporting after shoulder stabilization procedures is heavily reliant on patient-reported outcome measures (PROMs) such as the Single Assessment Numeric Evaluation (SANE), the Rowe instability score, the American Shoulder and Elbow Surgeons (ASES) score, and the visual analog scale (VAS) for pain. 12,14,17,20,24,[32][33][34] Given the frequency with which these measures are used to evaluate surgical outcomes, it is imperative that the clinical relevance for these measures be understood. Commonly used clinical significance thresholds include the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS).…”

“…6,21,29,35,37,41 Military populations are known to be at an increased risk for posterior instability because of the high-demand shoulder activities required as a part of routine military training and therefore represent a unique opportunity to study this abnormality. 17,32,35,37,41 Although operative management is often indicated for the treatment of posterior instability, 2,29,32 outcomes after posterior stabilization remain incompletely understood compared with after anterior labral repair.…”

Outcomes Following Combined Posterior Labral and SLAP Repair in Military Patients Younger Than 35 Years

“…13,26,27,31 This is believed to be attributable to the repetitive, high shoulder-demand activities required as a part of routine military training. [23][24][25] Although the incidence of combined posterior glenohumeral instability and SLAP tears has not been defined, concomitant SLAP lesions have been reported to occur in 20% to 54% of patients with anterior instability. 9,32 Given the high number of reported incidences of posterior instability and SLAP lesions in military populations, it is reasonable to hypothesize that combined posterior labral and SLAP tears may represent a significant source of morbidity among these patients.…”