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The Incidence of Posterior and Combined AP Shoulder Instability Treatment with Surgical Stabilization Is Higher in an Active Military Population than in the General Population: Findings from the US Naval Academy.

Authors :
Yow BG
Wade SM
Bedrin MD
Rue JH
LeClere LE
Source :
Clinical orthopaedics and related research [Clin Orthop Relat Res] 2021 Apr 01; Vol. 479 (4), pp. 704-708.
Publication Year :
2021

Abstract

Background: Anterior instability has consistently been shown to be the most common type of glenohumeral instability. Recent studies have demonstrated a higher percentage of posterior and combined (anterior and posterior) instability than had previously been reported; however, this work has not been replicated recently in a particularly young military population, which may be representative of an especially athletic or high-demand group.<br />Question/purpose: What proportion of arthroscopic shoulder stabilization procedures are performed to address isolated anterior instability, isolated posterior instability, and combined instability in a young, military population?<br />Methods: Between August 2009 and January 2020, two sports medicine fellowship-trained surgeons performed arthroscopic shoulder surgery on 543 patients at a single institution. During that time, the indication to be treated with arthroscopic stabilization surgery was symptomatic glenohumeral instability, as diagnosed by the operative surgeon, that restricted patients from carrying out their military duties. Of those, 82% (443 of 543) could be evaluated in this retrospective study, while 18% (100 of 543) were excluded due to either incomplete data or because the procedure performed was not to address instability. No patient underwent an open stabilization procedure during this period. Of the 443 patients investigated, the mean age was 22 ± 4 years, and 88% (392 of 443 patients) were men. Instability type was characterized as isolated anterior, isolated posterior, or combined (anterior and posterior) according to the physician's diagnosis as listed in the patient's clinical records and operative reports after the particular capsulolabral pathology was identified and addressed.<br />Results: Isolated anterior instability occurred in 47% of patients (210 of 443). Isolated posterior instability happened in 18% of patients (80 of 443), while combined anteroposterior instability occurred in 35% of patients (153 of 443).<br />Conclusion: Shoulder instability is common in the military population. Although anterior instability occurred most frequently, these findings demonstrate higher proportions of posterior and combined instability than have been previously reported. Surgeons should have a heightened suspicion for posterior and combined anteroposterior labral pathology when performing arthroscopic stabilization procedures to ensure that these instability patterns are recognized and treated appropriately. The current investigation examines a unique cohort of young and active individuals who are at particularly high risk for instability and whose findings may represent a good surrogate for other active populations that a surgeon may encounter.Level of Evidence Level III; therapeutic study.<br />Competing Interests: Each author certifies that he, nor any member of his immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.<br /> (Copyright © 2020 by the Association of Bone and Joint Surgeons.)

Details

Language :
English
ISSN :
1528-1132
Volume :
479
Issue :
4
Database :
MEDLINE
Journal :
Clinical orthopaedics and related research
Publication Type :
Academic Journal
Accession number :
33094964
Full Text :
https://doi.org/10.1097/CORR.0000000000001530