Emma Torrance1,2, Ciaran J Clarke1,3, Puneet Monga2,4, Lennard Funk1,2,4, Michael J Walton1,2,4. 1. The Arm Clinic, HCA The Wilmslow Hospital, Wilmslow, UK. 2. University of Salford, Salford, UK. 3. Royal Bolton NHS Foundation Trust, Bolton, UK. 4. Wrightington Hospital, Wigan, UK.
Abstract
BACKGROUND: Traumatic glenohumeral dislocation of the shoulder is one of the most common shoulder injuries, especially among adolescent athletes. The treatment of instability for young athletes continues to be controversial owing to high recurrence rates. PURPOSE: To investigate the recurrence rate of shoulder instability after arthroscopic capsulolabral repair for adolescent contact and collision athletes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Sixty-seven patients aged <18 years underwent an arthroscopic labral repair over a 5-year period. The mean ± SD age of the cohort was 16.3 ± 0.9 years (range, 14-17 years) and consisted of 1 female and 66 males. All patients were contact athletes, with 62 of 67 playing rugby. Demographic, clinical, and intraoperative data for all patients with shoulder instability were recorded in our database. Recurrence rates were recorded and relative risks calculated. RESULTS: At a follow-up of 33 ± 20 months, 34 of 67 patients had recurrent instability for an overall recurrence rate of 51% among adolescent contact athletes after arthroscopic labral repair surgery. The mean time to recurrence was 68.1 ± 45.3 weeks. All recurrences occurred as a result of a further sporting injury. Relative risk analysis demonstrated that athletes aged <16 years had 2.2 (95% CI, 1.2-2.1) times the risk of developing a further instability episode as compared with athletes aged ≥16 years at the time of index surgery ( P = .0002). The recurrence rate among adolescent athletes after bony Bankart repairs was 57.9% versus 47.9% for soft tissue labral repairs ( P = .4698). The incidence of Hill-Sachs lesions ( P = .0002) and bony Bankart lesions ( P = .009) among adolescent athletes was significantly higher than among adult controls ( P = .002). The presence of bone loss did not lead to a significant increase in recurrence rate over and above the effect of age. CONCLUSION: Adolescent contact athletes undergoing arthroscopic labral repair have an overall recurrence rate of 51%. Rugby players who undergo primary arthroscopic shoulder stabilization aged <16 years have 2.2 times the risk of developing a further instability episode when compared with athletes aged ≥16 years at the time of index surgery, with a recurrence rate of 93%.
BACKGROUND:Traumatic glenohumeral dislocation of the shoulder is one of the most common shoulder injuries, especially among adolescent athletes. The treatment of instability for young athletes continues to be controversial owing to high recurrence rates. PURPOSE: To investigate the recurrence rate of shoulder instability after arthroscopic capsulolabral repair for adolescent contact and collision athletes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Sixty-seven patients aged <18 years underwent an arthroscopic labral repair over a 5-year period. The mean ± SD age of the cohort was 16.3 ± 0.9 years (range, 14-17 years) and consisted of 1 female and 66 males. All patients were contact athletes, with 62 of 67 playing rugby. Demographic, clinical, and intraoperative data for all patients with shoulder instability were recorded in our database. Recurrence rates were recorded and relative risks calculated. RESULTS: At a follow-up of 33 ± 20 months, 34 of 67 patients had recurrent instability for an overall recurrence rate of 51% among adolescent contact athletes after arthroscopic labral repair surgery. The mean time to recurrence was 68.1 ± 45.3 weeks. All recurrences occurred as a result of a further sporting injury. Relative risk analysis demonstrated that athletes aged <16 years had 2.2 (95% CI, 1.2-2.1) times the risk of developing a further instability episode as compared with athletes aged ≥16 years at the time of index surgery ( P = .0002). The recurrence rate among adolescent athletes after bony Bankart repairs was 57.9% versus 47.9% for soft tissue labral repairs ( P = .4698). The incidence of Hill-Sachs lesions ( P = .0002) and bony Bankart lesions ( P = .009) among adolescent athletes was significantly higher than among adult controls ( P = .002). The presence of bone loss did not lead to a significant increase in recurrence rate over and above the effect of age. CONCLUSION: Adolescent contact athletes undergoing arthroscopic labral repair have an overall recurrence rate of 51%. Rugby players who undergo primary arthroscopic shoulder stabilization aged <16 years have 2.2 times the risk of developing a further instability episode when compared with athletes aged ≥16 years at the time of index surgery, with a recurrence rate of 93%.
Authors: Ignacio Pasqualini; Luciano Andrés Rossi; Franco Luis De Cicco; Ignacio Tanoira; Ignacio Alonso Hidalgo; Santiago Bongiovanni; Diego Hernán Giunta; Maximiliano Ranalletta Journal: Shoulder Elbow Date: 2021-02-17
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
Authors: Peter N Chalmers; Bradley Hillyard; Jun Kawakami; Garrett Christensen; Dillon O'Neill; Victoria Childress; Robert Z Tashjian Journal: JSES Int Date: 2020-05-30