Search

Objective: To report the injury characteristics, radiographic findings, and long-term outcomes of nonoperative management for posterior shoulder instability (PSI)., Design: A retrospective review of 143 patients with PSI using a large geographic database., Setting: Single county between January 1994 and July 2012., Patients: A clinical history and diagnosis of PSI, one confirmatory imaging study to support the diagnosis, and a minimum of 5 years follow-up were required for inclusion. Patients with seizure disorders, anterior-only instability, multidirectional instability, and superior labrum from anterior to posterior diagnosis were excluded., Interventions: Patients with PSI were managed nonoperatively or operatively., Main Outcome Measures: Pain, recurrent instability, and progression into glenohumeral osteoarthritis at long-term follow-up., Results: One hundred fifteen patients were identified. Thirty-seven (32%) underwent nonoperative management. Twenty (54%) patients were diagnosed with posterior subluxation, 3 (8%) with a single dislocation, and 7 (19%) with multiple dislocations. Symptomatic progression of glenohumeral arthritis was observed in 8% (3) of patients. Pain improved in 46% (17) of patients and worsened in 19% (7). Recurrent instability and progression to osteoarthritis occurred in 15% (3/20) of patients with a traumatic instability event compared with 0% of atraumatic patients after nonoperative management (P = 0.234). Pain at follow-up was more common in nonoperative than operative patients (P = 0.017)., Conclusions: Nonoperative management is a viable option for many patients with posterior shoulder instability; however, many may continue to have posterior shoulder pain., Competing Interests: J. Lee: Arthrex, Inc: Paid presenter or speaker; Biomet Sports Medicine, LLC: Hospitality payments; Encore Medical: Hospitality payments; Peerless Surgical, Inc: Education; Sequoia Surgical: Education; and Wright Medical Technology: Hospitality payments. A. J. Krych: Aesculap/B.Braun: Research support; American Journal of Sports Medicine: Editorial or governing board; Arthrex, Inc: IP royalties and Paid consultant; Arthritis Foundation: Research support; Ceterix: Research support; Exactech: Research support; Gemini Medical: Research support; Histogenics: Research support; International Cartilage Repair Society: Board or committee member; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: Board or committee member. JRF Ortho: Paid consultant; Minnesota Orthopedic Society: Board or committee member; Musculoskeletal Transplantation Foundation: Board or committee member; Open Payments Database: Musculoskeletal Transplant Foundation (2013/15/16) and Arthrex INC (2014/15/16) for compensation for services such as serving as faculty or speaker, for consulting fees, for travel/lodging, for food/beverage, and for honoraria; DePuy (2014): consulting fees; Responsive Arthroscopy LLC: Shareowner; and Vericel: Paid consultant. D. L. Dahm: AJSM Medical Publishing Board of Trustees: Editorial or governing board; American Orthopaedic Society for Sports Medicine: Board or committee member; Arthrex, Inc: Research support; NBA/GE Strategic Advisory Board: Board or committee member; Spouse owns stock in Tenex Health, Inc and Sonex Health, LLC: Stock or stock Options; Spouse receives royalties from Tenex Health, Inc and Sonex Health, LLC: IP royalties; Open Payments Database: GE Healthcare: Travel and Lodging. CC: Arthrex (hospitality payments); and Zimmer Biomet: hospitality payments (2015). The other authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: While a large volume of literature has focused on risk factors for anterior shoulder instability, the rates of recurrence are inconsistent and require additional population-based epidemiologic data., Purpose/hypothesis: The purpose was to report the effect of patient age on the number of instability events before physician consultation, rate of surgical stabilization, recurrent instability, and progression to osteoarthritis in patients <40 years old with anterior shoulder instability, utilizing an established US geographic population. We hypothesized that younger patients would be more likely to experience multiple episodes of instability before evaluation, undergo surgery, and experience recurrent instability after surgical intervention., Study Design: Descriptive epidemiologic study., Methods: An established geographic database of more than 500,000 patients was used to identify patients <40 years of age with anterior shoulder instability between 1994 and 2016. Medical records were reviewed to obtain patient characteristics, history, imaging, surgical details, and outcomes. Patients were divided into 5 groups based on age (≤15, 16-20, 21-25, 26-30, and 31-40 years) at initial instability. Comparative analysis was performed to identify differences between groups., Results: The study population consisted of 654 patients with a mean follow-up of 11.1 years (range, 2.0-25.2 years). This resulted in 118 patients (18%) ≤15 years of age at initial instability; 250 (38%), 16 to 20 years; 110 (17%), 21 to 25 years; 80 (12%), 26 to 30 years; and 96 (15%), 31 to 40 years. Of patients ≤15 years old at initial instability 47% had 3+ instability events, compared with 12% of patients aged 31 to 40 years ( P < .001). At 10 years of follow-up, patients ≤15 and 16 to 20 years old demonstrated the highest recurrent instability rates of 38.8% and 47.1% after nonoperative management, respectively. Patients 16 to 20 years old demonstrated the highest rates of both surgical intervention (40.4%) and recurrence after surgery (24.8%). Patients 31 to 40 years of age were significantly more likely to develop clinically symptomatic osteoarthritis (15.6%) than all other age groups., Conclusion: In a US epidemiologic population of patients <40 years old, the rate of recurrent anterior shoulder instability was roughly one-third after initial physician consultation. Younger patients, particularly those ≤15 and 16 to 20 years of age, were more likely to have experienced multiple instability events at the time of initial evaluation, require surgery, and experience recurrent instability compared with older patients. For every year of decrease in age at initial instability, the risk of recurrent instability or surgical intervention after physician consultation increased by 4.1% and 2.8%, respectively.