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Arthroscopic approach controls posterior shoulder instability

Source: Medscape News

Arthroscopic capsulolabral posterior reconstruction offers advantages in posterior shoulder instability, according to researchers.

More than 90% of athletes treated for the condition in this manner are able to return to sports, Dr. James P. Bradley told Reuters Health by email.

While glenohumeral instability is relatively common, affecting 2% of the general population, posterior instability is much rarer, affecting 2% to 10% of all unstable shoulders, according to a 2011 paper in Sports Medicine (see http://1.usa.gov/15g2OcX). Posterior glenohumeral instability is mainly seen in athletes.

In a June 26 online paper in The American Journal of Sports Medicine, Dr. Bradley of the University of Pittsburgh Medical Center and colleagues observe that there are few reports of arthroscopic treatment of unidirectional posterior shoulder instability.

For the current paper, the team expanded on an earlier evaluation to include 200 shoulders in 183 athletes. All had unidirectional recurrent posterior glenohumeral instability treated with arthroscopic posterior capsulolabral reconstruction.

At a mean of 36 months postoperatively, the mean American Shoulder and Elbow Surgeons (ASES) score increased from 45.9 to 85.1. There were also significant improvements in subjective measures of stability, pain, and function.

Overall, 188 shoulders (94%) had excellent or good results on the ASES scale at the latest follow-up, and similar proportions of patients had excellent or good results on subjective measures of stability, and in terms of patient-described subjective satisfactory or full range of motion.

When a subset of 117 shoulders of contact athletes was compared with the whole cohort of 200 shoulders, no significant differences were seen.

Return to play was significantly more common among the 156 patients who had anchored plications than among the 44 with anchorless intraoperative soft tissue fixation (92% versus 84%). The anchored plication group also had higher mean ASES scores

In total, 90% of patients were able to return to sports and 64% were able to return to the same level postoperatively.

Although most articles on open repair do not address sports return, Dr. Bradley pointed out, one reported that 29% of patients were unable to return to recreational sports.

Overall, he concluded, “the data clearly demonstrate that the arthroscopic approach is superior to open techniques when compared to the historic open literature.”

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