Anterior Should Instability in Sports: In-Season & Off-Season Treatment

Research Paper Title

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

Background

The debate continues regarding the optimal treatment of intercollegiate contact athletes with in-season anterior shoulder instability.

Purpose

To examine return to sport and recurrent instability in the season after the index in-season anterior instability event.

Study Design

Cohort study; Level of evidence, 2.

Methods

Forty-five contact intercollegiate athletes treated non-operatively or with arthroscopic stabilization were prospectively followed in a multi-centre observational study to evaluate return to play (RTP) and recurrent instability in the season after an initial in-season anterior glenohumeral instability event. Baseline data collection included sport played, previous instability events, direction of instability, type of instability (subluxation or dislocation), and treatment method (nonoperative management or arthroscopic stabilisation). All non-operatively treated athletes underwent a standardised accelerated rehabilitation programme without shoulder immobilization. Surgical stabilisation was performed arthroscopically in all cases, and successful RTP was evaluated during the next competitive season after complete rehabilitation.

Results

Thirty-nine of 45 intercollegiate contact athletes had remaining National Collegiate Athletic Association eligibility and were followed through the subsequent competitive season after the index instability event. Of the 10 athletes electing nonoperative treatment, 4 (40%) successfully returned to play without recurrence during the subsequent season. Of the 29 athletes treated surgically, 26 (90%) were able to successfully return to play without recurrence the following season (recurrence: n = 1; inadequate function: n = 2). Athletes who underwent surgical reconstruction before the next season were 5.8 times (95% CI, 1.77-18.97; P = .004) more likely to complete the subsequent season without recurrent instability. Of the 29 athletes electing surgical stabilisation, there was no difference (risk ratio, 0.95; 95% CI, 0.10-9.24; P > .99) in RTP between the 9 stabilized after a single instability event (90% RTP rate) and the 20 stabilised after multiple in-season recurrent instability events (89% RTP rate).

Conclusions

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.

Reference

Dickens, J.F., Rue, J.P., Cameron, K.L., Tokish, J.M., Peck, K.Y., Allred, C.D., Svoboda, S.J., Sullivan, R., Kilcoyne, K.G. & Owens, B.D. (2017) Successful Return to Sport After Arthroscopic Shoulder Stabilization Versus Nonoperative Management in Contact Athletes With Anterior Shoulder Instability: A Prospective Multicenter Study. The American Journal of Sports Medicine. 45(11), pp.2540-2546. doi: 10.1177/0363546517712505. Epub 2017 Jun 28.

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