E Cruz-Ferreira1, P Abadie2, A Godenèche3, P Mansat4, P Clavert5, P Flurin6. 1. Orthopaedic Surgery Fellow, Clinique du Sport Bordeaux, 4, rue Négrevergne, 33700 Mérignac, France; Orthopaedic Surgery, Sousa Martins Hospital, City of Guarda, Portugal; Faculdade de Ciências da Saúde, Universidade da Beira Interior, City of Covilhã, Portugal. 2. Centre de chirurgie orthopédique et sportive, clinique du sport de Bordeaux-Mérignac, 2, rue Nègrevergne, 33700 Mérignac, France. Electronic address: pierreabadie1@gmail.com. 3. Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France. 4. CHU de Toulouse, hôpital de Purpan, 1, place du Docteur-Baylac, 31300 Toulouse, France. 5. Centre de chirurgie orthopedique et de la main (CCOM), CHU de Strasbourg, 10, avenue Achille-Baumann, 67400 Illkirch, France. 6. Centre de chirurgie orthopédique et sportive, clinique du sport de Bordeaux-Mérignac, 2, rue Nègrevergne, 33700 Mérignac, France.
Abstract
BACKGROUND: The management of posterior shoulder instability remains controversial. Consequently, for a symposium on this topic, the French Arthroscopy Society (SFA) conducted a prospective multicentre study comparing outcomes of operative and non-operative treatment. OBJECTIVE: To compare outcomes after operative versus non-operative treatment of posterior shoulder instability. HYPOTHESIS: The surgical treatment of posterior shoulder instability may achieve better clinical outcomes than non-operative treatment in selected patients. MATERIAL AND METHODS: Fifty-one patients were included prospectively then followed-up for 12months. Three groups were defined based on the clinical presentation: recurrent dislocation or subluxation, involuntary instability or voluntary instability that had become involuntary, and shoulder pain with instability. Of the 51 patients, 19 received non-operative therapy involving a three-step rehabilitation programme and 32 underwent surgery with a posterior bone block, labral repair and/orcapsule tightening, or bone defect filling. At inclusion and at last follow-up, the Subjective Shoulder Value (SSV), Rowe score, Walch-Duplay score, and Constant score were determined. RESULTS: The preliminary results after the first 12 months are reported here. In the non-operative and operative groups, the Constant score was 78 versus 87, the Rowe score 64 versus 88, and the Walch-Duplay score 69 versus 82, respectively. These differences were statistically significant (P<0.05). DISCUSSION: To our knowledge, this study is the first comparison of non-operative versus operative treatment in a cohort of patients with documented posterior shoulder instability. Outcomes were better with operative treatment. However, this finding remains preliminary given the short follow-up of only 1 year. LEVEL OF EVIDENCE: III, case-control study.
BACKGROUND: The management of posterior shoulder instability remains controversial. Consequently, for a symposium on this topic, the French Arthroscopy Society (SFA) conducted a prospective multicentre study comparing outcomes of operative and non-operative treatment. OBJECTIVE: To compare outcomes after operative versus non-operative treatment of posterior shoulder instability. HYPOTHESIS: The surgical treatment of posterior shoulder instability may achieve better clinical outcomes than non-operative treatment in selected patients. MATERIAL AND METHODS: Fifty-one patients were included prospectively then followed-up for 12months. Three groups were defined based on the clinical presentation: recurrent dislocation or subluxation, involuntary instability or voluntary instability that had become involuntary, and shoulder pain with instability. Of the 51 patients, 19 received non-operative therapy involving a three-step rehabilitation programme and 32 underwent surgery with a posterior bone block, labral repair and/orcapsule tightening, or bone defect filling. At inclusion and at last follow-up, the Subjective Shoulder Value (SSV), Rowe score, Walch-Duplay score, and Constant score were determined. RESULTS: The preliminary results after the first 12 months are reported here. In the non-operative and operative groups, the Constant score was 78 versus 87, the Rowe score 64 versus 88, and the Walch-Duplay score 69 versus 82, respectively. These differences were statistically significant (P<0.05). DISCUSSION: To our knowledge, this study is the first comparison of non-operative versus operative treatment in a cohort of patients with documented posterior shoulder instability. Outcomes were better with operative treatment. However, this finding remains preliminary given the short follow-up of only 1 year. LEVEL OF EVIDENCE: III, case-control study.
Authors: Matthew L Vopat; Reed G Coda; Nick E Giusti; Jordan Baker; Armin Tarakemeh; John P Schroeppel; Scott Mullen; Jeffrey Randall; Matthew T Provencher; Bryan G Vopat Journal: Orthop J Sports Med Date: 2021-05-25