Successful Return to Sport After Arthroscopic Shoulder Stabilization Versus Nonoperative Management in Contact Athletes With Anterior Shoulder Instability: A Prospective Multicenter Study

Dickens, Jonathan; Rue, John-Paul; Cameron, Kenneth L.; Tokish, John M.; Peck, Karen Y.; Allred, C. Dain; Svoboda, Steven J.; Sullivan, Robert T.; Kilcoyne, Kelly G.; Owens, Brett D.

doi:10.1177/0363546517712505

Cited by 86 publications

(95 citation statements)

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“…Findings are relevant to athletes engaged in overhead sporting activities 1,3 where deficiencies in thoracic extension may place more stress on other components of the kinetic chain resulting in pain, altered performance, and impact on an athlete's ability to train and compete. 1 Whilst a recent review found inconclusive evidence of a relationship between static thoracic posture and shoulder complaints, 15 functional kinetic chains are dynamic, requiring a variable mix of movement, motor control, and strength across the component parts, including the thoracic spine to enable performance of skilled functional Upper thoracic Crosbie et al 38 Extension 2 [1,3] Lateral flexion (Ipsilateral) 3 [2,3] Rotation (Ipsilateral) 7 [5,9] Lower thoracic Crosbie et al 38 Extension 6 [4,8] Lateral flexion (Contralateral) 3 [2,4] Rotation Rotation (Ipsilateral) 7 [5,9] Lower thoracic Crosbie et al 38 Extension 2 [1,2] Lateral flexion (Contralateral) 7 [5,8] 38 Stewart et al 37 Extension…”

Section: Unilateral Shoulder Movementmentioning

confidence: 99%

“…Complaints are not however limited to arm‐dominant sports with comparable levels of 47% seen in football and 54% in swimming . Many studies have investigated approaches to management of sport‐related shoulder injuries, for example of the rotator cuff, acromioclavicular, and glenohumeral joints; with many athletes likely managed conservatively in line with current clinical guidelines . Notwithstanding implementation of evidence‐based management, many athletes go on to experience recurrent problems, with one report suggesting a 72% re‐injury rate for young athletes with shoulder instability …”

Section: Introductionmentioning

confidence: 99%

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Thoracic spine mobility, an essential link in upper limb kinetic chains in athletes: A systematic review

et al. 2019

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Knowledge of the contribution of the thoracic spine movement, a requisite for UL functional movement, offers the potential for novel directions for research and management in rehabilitation. This systematic reviewed synthesized evidence of thoracic spine mobility during UL movement in athletes. Using three reviewers at each stage, key databases (MEDLINE, CINAHL, Web of Science) were searched up to 30/6/18. Eligibility criteria: adults age 18‐40 (reflecting athletic population) and studies assessing thoracic spine and UL movement. Quality assessment was evaluated using AXIS tool and GRADE for overall quality of evidence. Seven studies were included (n = 168, mean age 26.4 years, 33% males) with n = 20 in an athlete population. Main findings were: Unilateral and bilateral UL flexion resulted in 6.7‐8.0 and 12.0‐12.8° thoracic extension, respectively. Unilateral and bilateral UL abduction resulted in 3.0‐4.0 and 9.0‐15.0 and degrees, respectively. Other thoracic spine movement (lower and upper, rotation and lateral flexion) was variable across movement planes. Overall there was unequivocal evidence of thoracic spine movement, mainly extension during UL movement and notably at the end of elevation across all planes. Findings support further targeted high‐quality research and examination of thoracic mobility, an essential link in the kinetic chain, in practice.

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Section: Unilateral Shoulder Movementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Thoracic spine mobility, an essential link in upper limb kinetic chains in athletes: A systematic review

et al. 2019

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confidence: 99%

“…The prognosis of anterior shoulder instability (ASI) has been well-studied in both cohorts treated nonoperatively 5 , 10 , 16 and operatively. 1 – 7 , 14 , 20 , 24 Neer et al 15 were among the first authors to describe glenohumeral arthritis as a consequence of recurrent shoulder instability, and numerous studies since then have identified a high rate of glenohumeral arthropathy. 2 , 3 , 6 , 7 , 16 Hovelius and Saeboe 10 reported that 55% of patients who sustained a first-time anterior shoulder dislocation before the age of 40 years displayed some degree of arthropathy on radiographs after 25-year follow-up.…”

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confidence: 99%

Incidence of and Risk Factors for Glenohumeral Osteoarthritis After Anterior Shoulder Instability: A US Population–Based Study With Average 15-Year Follow-up

Kruckeberg

Leland

Bernard

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The rate of osteoarthritis (OA) in patients with a history of previous anterior shoulder instability (ASI) varies within the literature, with the majority of studies investigating rates after surgical stabilization. ASI appears to lead to increased rates of OA, although risk factors for developing OA in cohorts treated nonoperatively and operatively are not well-defined. Purpose: To determine the incidence of clinically symptomatic OA and identify potential risk factors for the development of OA in patients younger than 40 years with a known history of ASI. Study Design: Case-control study; Level of evidence, 3. Methods: An established, geographically based database was used to identify patients in the United States who were younger than 40 years and were diagnosed with ASI between 1994 and 2014. Patient information, including demographic, imaging, and surgical details, was collected. Comparative analysis was performed between groups with and without OA at final follow-up as well as between patients who underwent surgical and nonsurgical management. Results: The study population consisted of 154 patients with a mean follow-up of 15.2 years (range, 5.1-29.8 years). The mean age at initial instability event was 20.9 years (95% CI, 19.9-22.0 years). Overall, 22.7% of patients developed clinically symptomatic glenohumeral OA. Multivariate analysis revealed that current or former smokers (odds ratio [OR], 4.3; 95% CI, 1.1-16.5; P = .030), hyperlaxity (OR, 10.1; 95% CI, 1.4-72.4; P = .020), laborer occupation (OR, 6.1; 95% CI, 1.02-36.1; P = .043), body mass index (BMI) (OR, 1.2; 95% CI, 1.03-1.3; P = .012), and age at initial instability (OR, 1.1; 95% CI, 1.02-1.2; P = .013) as potential independent risk factors when accounting for other demographic and clinical variables. Conclusion: In a US geographic population of patients younger than 40 years with ASI, approximately one-fourth of patients developed symptomatic OA at a mean follow-up of 15 years from their first instability event. When accounting for differences in patient demographic and clinical data, we noted a potentially increased risk for the development of OA in patients who are current or former smokers, have hyperlaxity, are laborers, have higher BMI, and have increased age at initial instability event. Smoking status, occupation, and BMI are modifiable factors that could potentially decrease risk for the development of symptomatic OA in these patients.

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“…reports American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and American Shoulder and Elbow Surgeons (board or committee member); Arthrex (IP royalties; paid consultant; paid presenter or speaker); Arthroscopy (editorial or governing board); Arthroscopy Association of North America (board or committee member); International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (board or committee member); Joint Restoration Foundation ( have greater, or even partially increased risk of recurrence, the time to stabilize is early after dislocation. [4][5][6][7][8] What is increasingly demonstrated in the literature is that there is a cost to recurrence of instability of the glenohumeral joint. There is no question that with more recurrent instability events (meaning heredmore than 2), there are (1) more anterior labroligamentous periosteal sleeve avulsion (ALPSA) tears, which carry with them an increased risk of failure after surgical stabilization 9,10 ;…”

mentioning

confidence: 99%

Editorial Commentary: Evidence to Support Surgical Intervention for First-Time Shoulder Instability: Stabilize Them Early!

Provencher

Midtgaard

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Historically, a primary anterior instability event has been treated nonoperatively. In the literature, a multitude of outcome scores and definitions for recurrence of instability complicates the interpretation and synthesis of evidencebased recommendations. However, there is an emerging body of high-quality evidence that early surgical stabilization yields better overall outcomes. A wait-and-see approach would be acceptable if it was without detrimental effects, but there is a cost to recurrence of instability events, such as more extensive soft-tissue, cartilage, and bony lesions. Young age, male sex, and contact sport participation have been identified as risk factors for recurrence of anterior shoulder instability, and today, these patients are routinely recommended surgical treatment. It is also paramount to identify concomitant injury following the primary anterior instability event. The sensitivity, specificity, and reliability of radiographs is suboptimal, and the threshold to obtain advanced imaging such as computed tomography or magnetic resonance imaging with 3-dimensional reconstructions should be low. Taking into account the low non-recurrence complication rate following arthroscopic stabilization, early surgical intervention should be considered following the first instability event.

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Successful Return to Sport After Arthroscopic Shoulder Stabilization Versus Nonoperative Management in Contact Athletes With Anterior Shoulder Instability: A Prospective Multicenter Study

Abstract: Collegiate contact and collision athletes with in-season anterior shoulder instability are significantly more likely to successfully return to sport without subsequent instability events the next season if they undergo surgical repair in the off-season.

Cited by 86 publications

References 32 publications

Thoracic spine mobility, an essential link in upper limb kinetic chains in athletes: A systematic review

Thoracic spine mobility, an essential link in upper limb kinetic chains in athletes: A systematic review

Incidence of and Risk Factors for Glenohumeral Osteoarthritis After Anterior Shoulder Instability: A US Population–Based Study With Average 15-Year Follow-up

Editorial Commentary: Evidence to Support Surgical Intervention for First-Time Shoulder Instability: Stabilize Them Early!

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