Jonathan F Dickens1,2, John-Paul Rue2,3, Kenneth L Cameron4, John M Tokish2,5, Karen Y Peck4, C Dain Allred6, Steven J Svoboda2,4, Robert Sullivan2,6, Kelly G Kilcoyne2,7, Brett D Owens2,8. 1. Walter Reed National Military Medical Center, Bethesda, Maryland, USA. 2. Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. 3. Naval Health Clinic Annapolis, United States Naval Academy, Annapolis, Maryland, USA. 4. Keller Army Community Hospital, United States Military Academy, West Point, New York, USA. 5. Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA. 6. University of Arizona, Tucson, Arizona, USA. 7. William Beaumont Army Medical Center, El Paso, Texas, USA. 8. Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
Abstract
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 nonoperatively or with arthroscopic stabilization were prospectively followed in a multicenter 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 stabilization). All nonoperatively treated athletes underwent a standardized accelerated rehabilitation program without shoulder immobilization. Surgical stabilization 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 stabilization, 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 stabilized after multiple in-season recurrent instability events (89% RTP rate). CONCLUSION: 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.
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 nonoperatively or with arthroscopic stabilization were prospectively followed in a multicenter 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 stabilization). All nonoperatively treated athletes underwent a standardized accelerated rehabilitation program without shoulder immobilization. Surgical stabilization 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 stabilization, 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 stabilized after multiple in-season recurrent instability events (89% RTP rate). CONCLUSION: 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.
Authors: Just A van der Linde; Judith E Bosmans; Dirk P Ter Meulen; Derk A van Kampen; Derek Fp van Deurzen; Robert Haverlag; Daniel Bf Saris; Michel Pj van den Bekerom Journal: Shoulder Elbow Date: 2018-05-14
Authors: Adam Kwapisz; Ellen Shanley; Amit M Momaya; Chris Young; Michael J Kissenberth; Stefan J Tolan; Keith T Lonergan; Douglas J Wyland; Richard J Hawkins; Stephan G Pill; John M Tokish Journal: Sports Health Date: 2020-09-03 Impact factor: 3.843
Authors: John M Tokish; Charles A Thigpen; Michael J Kissenberth; Stefan J Tolan; Keith T Lonergan; John M Tokish; Jonathan F Dickens; Richard J Hawkins; Ellen Shanley Journal: Sports Health Date: 2020-07-01 Impact factor: 3.843
Authors: David J Tennent; Sean E Slaven; Mark A Slabaugh; Kenneth L Cameron; Matthew A Posner; Brett D Owens; Lance E LeClere; John-Paul H Rue; John M Tokish; Jonathan F Dickens Journal: Clin Orthop Relat Res Date: 2021-04-01 Impact factor: 4.176
Authors: Hassanin Alkaduhimi; James W Connelly; Derek F P van Deurzen; Denise Eygendaal; Michel P J van den Bekerom Journal: Arthrosc Sports Med Rehabil Date: 2021-04-06