Arthroscopic Soft Tissue Stabilization With Selective Augmentations for Traumatic Anterior Shoulder Instability in Competitive Collision Athletes

Abstract

Background: Many surgeons prefer bony stabilization including Bristow or Latarjet procedures for shoulder instability in collision athletes, even though several potential complications have been reported. There has been a limited number of studies on the midterm outcomes of arthroscopic soft tissue stabilization for anterior shoulder instability in competitive collision athletes. Purpose: To assess the outcomes of arthroscopic soft tissue stabilization in combination with selective augmentation procedures for collision athletes with traumatic anterior shoulder instability Study Design: Case series; Level of evidence, 4. Methods: We retrospectively assessed rugby or American football players (<40 years old) who underwent arthroscopic Bankart or bony Bankart repair with selective augmentations (rotator interval closure and/or Hill-Sachs remplissage) for traumatic anterior shoulder instability between January 2012 and March 2017. Shoulders that required other bony procedures were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score and Subjective Shoulder Value sports score) were investigated. Results: This study included 113 shoulders in 100 patients with a mean age of 20 years (range, 15-36 years) at surgery. Rotator interval closure was performed on 36 shoulders in addition to Bankart repair, and rotator interval closure and Hill-Sachs remplissage were performed on 77 shoulders. The mean follow-up period was 44 months (range, 24-72 months). Of the 113 shoulders, 4 (3.5%) experienced postoperative dislocation, but there were no complications. A total of 93 athletes (93%) attained complete or near complete preinjury sports activity levels. The mean Rowe score significantly improved from 36 (range, 10-75) at presurgery to 96 (range, 35-100; P = .003) at postsurgery. The mean Subjective Shoulder Value sports score significantly improved after surgery, from a mean preoperative score of 22 (range, 0-50) to a postoperative score of 92 (range, 64-100; P = .002). Conclusion: Our treatment strategy, where arthroscopic soft tissue stabilization was combined with selected augmentations, provided good clinical outcomes for competitive collision athletes in terms of low rates of recurrence and complication, a high rate of return to sports, and good shoulder function.

Pathology and surgical outcomes of unstable painful shoulders

“…Arthroscopic soft tissue stabilization was applied for all UPS, which is the same procedure as those for traumatic recurrent anterior shoulder instability that were described in previous articles. 15 , 23 , 24 All surgeries were performed in the beach chair position under general anesthesia by or under close supervision of one of the senior surgeons (H.S., N.T., K.M., and M.T.). Routine diagnostic arthroscopy was performed throughout the glenohumeral joint.…”

“…The bony Bankart lesion was repaired without resection of the fragment. 15 , 23 , 24 Other pathological lesions such as the superior labrum anterior to posterior (SLAP) lesion, capsular tear, HAGL lesion, and rotator cuff tear were also repaired as necessary. Rotator interval closure was performed as an augmentation for patients that were at a high risk of recurrence, such as younger athletes (<20 years) or collision and contact athletes.…”

“…Rotator interval closure was performed as an augmentation for patients that were at a high risk of recurrence, such as younger athletes (<20 years) or collision and contact athletes. 15 , 23 , 24 Hill-Sachs remplissage was also performed for young collision and contact athletes with a Hill-Sachs lesion and glenoid bone loss. 15 …”

“… 15 , 23 , 24 Hill-Sachs remplissage was also performed for young collision and contact athletes with a Hill-Sachs lesion and glenoid bone loss. 15 …”

Clinical outcomes of Gaelic Athletic Association athletes after surgical stabilization in the setting of anterior shoulder instability

“…Although much literature in relation to anterior shoulder instability in collision athletes focuses on athletes partaking in American football, hockey, and rugby, Gaelic Athletic Association (GAA) games such as Gaelic football and hurling are collision sports claimed to be the most commonly played sports on the island of Ireland. 2 , 10 , 22 , 25 However, GAA games have increasing popularity with over 400 clubs established worldwide outside of Ireland, leading to over 50,000 registered GAA players in the United States alone. 26 In their previous study, Clesham and Shannon reported excellent functional outcomes with a moderate recurrence rate after ABR in 31 GAA athletes at medium-term follow-up.…”