1
|
Mouchantaf M, Bastard C, Corsia S, Métais P, Nourissat G. High Rates of Return to Play and Low Recurrence Rate After Arthroscopic Latarjet Procedure for Anterior Shoulder Instability in Rugby Players. Arthrosc Sports Med Rehabil 2024; 6:100912. [PMID: 38590787 PMCID: PMC10999816 DOI: 10.1016/j.asmr.2024.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/09/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose To analyze the rate of return to play, changes in athletic level, and recurrence rate and to report subjective outcomes in a series of rugby players with anterior shoulder instability who underwent an arthroscopic Latarjet procedure. Methods A multicenter retrospective study done in 2 centers on rugby players who were operated on between January 2011 and December 2020 was performed. Rugby players who underwent arthroscopic Latarjet procedure for anterior shoulder stabilization with a minimum follow-up period of 2 years were included. Rugby players were grouped according to their competitive level in their country (recreational, regional, national, and international). Data collected included return to sport after surgery, time to return to rugby, athletic level before and after surgery, patient satisfaction, and subjective scores. Recurrence and apprehension rates were also evaluated. Results A total of 73 subjects were included. Mean age at time of surgery was 23 ± 5 years. Mean duration of follow-up was 5 ± 2.6 years. Eighty-four percent of rugby players returned to rugby within a mean period of 6.6 months. Initial athletic level was a significant factor (P = .012) for not returning to sport, with 67% of patients who initially played at a recreational level not returning to rugby and 33% of patients who initially played at a regional league level not returning. All national and international players returned to play. Of the 12 non-returning rugby players, only 30% did not return because of their shoulder. Mean Subjective Shoulder Value was 90 ± 9%. Recurrence rate was 7%. Conclusions Arthroscopic Latarjet procedure proved its efficacy in managing recurrent anterior shoulder instability in rugby players. Return to play was achieved in almost all cases, with low recurrence rates. Despite high global return to the same level of sport, the higher the level of competition, the harder it is for rugby players to resume sport at the same level. Level of Evidence Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Mark Mouchantaf
- Clinique de l’épaule–Paris, Clinique Maussins-Nollet, Ramsay Sante, Paris, France
| | - Claire Bastard
- Service de Chirurgie Orthopedique–Hôpital Saint-Antoine, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Simon Corsia
- Service de Chirurgie Orthopédique–Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
| | | | - Geoffroy Nourissat
- Clinique de l’épaule–Paris, Clinique Maussins-Nollet, Ramsay Sante, Paris, France
| |
Collapse
|
2
|
Clarke CJ, Torrance E, Gibson J, Brownson P, Funk L. Diagnosing the direction of shoulder instability in rugby players. Shoulder Elbow 2024; 16:33-37. [PMID: 38435041 PMCID: PMC10902408 DOI: 10.1177/17585732221092025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/18/2022] [Indexed: 03/05/2024]
Abstract
The muscular characteristics of rugby players may make diagnosing the direction of shoulder instability and labral pathology challenging. This study aimed to assess the accuracy of clinical examination and specifically instability tests, in diagnosing the direction of shoulder instability in rugby players. One-hundred-and-forty rugby players, who had undergone a shoulder stabilization procedure, over a 55-month period, were included in this study. The mean age was 21.5 years with 137 males. Data collected included clinical examination and intraoperative findings. The two were compared to calculate the diagnostic accuracy of special tests for instability. The Anterior Apprehension Test had good sensitivity (82.7%), specificity (100%) and PPV (100%) but poor NPV (55.8%). All posterior instability tests demonstrated a sensitivity of over 85%, but all had a specificity of 25% or less. In 83.6% of cases the direction of instability was correctly identified from history and examination. Anterior instability was correctly diagnosed in 78.9% of cases and posterior in 100.0%. The poor NPV of the anterior apprehension test suggests that clinicians should be suspicious of anterior instability in rugby shoulders even in the light of negative examination findings. Positive posterior instability tests are highly suggestive of posterior instability in rugby players.
Collapse
Affiliation(s)
| | | | - Jo Gibson
- Liverpool Shoulder Clinic, Liverpool, UK
| | | | - Lennard Funk
- Wrightington Hospital, Appley Bridge, Lancashire, UK
| |
Collapse
|
3
|
Bonnevialle N, Mattési L, Martinel V, Letartre R, Barret H, Mansat P. Outcomes at Long-term Follow-up After Open Latarjet Versus Open Bankart Repair in Rugby Players. Orthop J Sports Med 2023; 11:23259671231184394. [PMID: 37564951 PMCID: PMC10411275 DOI: 10.1177/23259671231184394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/13/2023] [Indexed: 08/12/2023] Open
Abstract
Background Because rugby is a collision sport, it exposes players to a high risk of recurrence after anterior shoulder stabilization. Therefore, the choice of surgical procedure warrants close attention in order to optimize the time to return to sport and the stability of the shoulder throughout the player's career. Hypothesis The open Latarjet procedure would allow for a faster return to play and provide a lower rate of recurrence than the open Bankart repair at long-term follow-up. Study Design Cohort study; Level of evidence, 3. Methods The study retrospectively enrolled 62 competitive rugby players who had undergone an anterior shoulder instability procedure and had at least 5 years of follow-up data. A total of 32 players treated with an open Bankart repair (BK group) were compared with 30 players (31 shoulders) treated with an open Latarjet procedure (LT group). Outcomes between groups were compared with the Rowe score, Walch-Duplay score, recurrence rate, and osteoarthritis evaluation on plain radiograph (Samilson classification). Results The recurrence rate was significantly higher at 18.8% for the BK group (mean follow-up, 6.9 ± 1.7 years) compared with 3.3% for the LT group (mean follow-up, 6.2 ± 1.4 years) (P = .04). No postoperative complications occurred in the BK group, whereas 1 infection and 1 hematoma required a second surgery in the LT group (P = .14). In the BK and LT groups, 97% and 90% of players, respectively, were able to return to rugby at the same level or higher (P = .27), at a mean time of 8 and 6.3 months, respectively (P = .03). The mean Rowe and Walch-Duplay scores were not significantly different between the groups; however, the osteoarthritis rate was significantly higher in the BK versus the LT group (68% vs 38%, respectively; P = .03); 23% of patients, all in the BK group, had Samilson grade 2 osteoarthritis. Conclusion The open Latarjet procedure outperformed the open Bankart procedure in terms of stability, time to return to play, and radiological outcomes at long-term follow-up in competitive rugby players.
Collapse
Affiliation(s)
| | - Lucas Mattési
- Clinique Universitaire du Sport, CHU de Toulouse, Toulouse, France
| | | | | | - Hugo Barret
- Clinique Universitaire du Sport, CHU de Toulouse, Toulouse, France
| | - Pierre Mansat
- Clinique Universitaire du Sport, CHU de Toulouse, Toulouse, France
| |
Collapse
|
4
|
Leahy TM, Kenny IC, Campbell MJ, Warrington GD, Purtill H, Cahalan R, Comyns TM, Harrison AJ, Lyons M, Glynn LG, O’Sullivan K. Injury Trends for School Rugby Union in Ireland: The Need for Position-specific Injury-prevention Programs. Sports Health 2023; 15:131-141. [PMID: 35354389 PMCID: PMC9808841 DOI: 10.1177/19417381221078531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Concern has been raised over the injury risk to school Rugby union (Rugby) players and the potential long-term health consequences. Despite the increase in studies for this cohort, the influence of playing position on injury incidence and presentation is unclear. PURPOSE To describe the incidence, nature and severity of match injuries for school Rugby in Ireland overall, and as a function of playing position. STUDY DESIGN Prospective cohort study. METHODS Data were collected from 15 male (aged 16-19 years) school Senior Cup teams across 2 seasons. In total, 339 players participated in season 1, whereas 326 players participated in season 2. Injury data were recorded onto a bespoke online platform. Match exposure was also recorded. RESULTS The incidence rate of match injuries (24-hour time loss) was 53.6 per 1000 hours. Across both seasons, 6810 days were lost from play due to injury. Forwards (65.4 per 1000 hours) sustained significantly more (P < 0.05) injuries than backs (40.5 per 1000 hours). The head, shoulder, knee, and ankle were the most common injured body regions; however, forwards sustained significantly more (P < 0.05) head and shoulder injuries than backs. The tackle was responsible for the majority of injuries in both groups. The highest proportion of injuries occurred during the third quarter. CONCLUSION Clear differences in injury presentation and incidence were evident when comparing forwards versus backs. The high rate of head and shoulder injuries in the forwards suggest the need for more targeted injury-prevention strategies and further research on education and laws around the tackle event. The spike of injuries in the third quarter suggests that fatigue or inadequate half-time warm-up may be a contributing factor warranting further exploration. CLINICAL RELEVANCE This study demonstrates clear differences in injury presentation according to playing position in school Rugby and highlights the need for a more tailored approach to the design and implementation of injury-prevention strategies. LEVEL OF EVIDENCE Level 3.
Collapse
Affiliation(s)
- Therese M. Leahy
- Therese M. Leahy MSc, PhD,
Researcher IRFU IRIS Project, Department of Physical Activity & Sports
Sciences, University of Limerick, Limerick, Clooneen, Headford, h91V06k, Ireland
() (Twitter: @ThereseMLeahy)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Hoshika S, Matsuki K, Tokai M, Morioka T, Ueda Y, Hamada H, Takahashi N, Sugaya H. Pathology and surgical outcomes of unstable painful shoulders. JSES Int 2022; 6:349-354. [PMID: 35572430 PMCID: PMC9091796 DOI: 10.1016/j.jseint.2022.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Boileau et al have reported on the unstable, painful shoulder (UPS), which was defined as painful shoulders without any recognized anteroinferior subluxations or dislocations that were associated with roll-over lesions (ie, instability lesions) on imaging or at arthroscopy. However, they included various pathologies, probably due to the ambiguity in their definitions of UPS. We redefined UPS as follows: (1) shoulder pain during daily or sports activities, (2) traumatic onset, (3) no complaint of shoulder instability, and (4) soft-tissue or bony lesions, such as Bankart or humeral avulsion of glenohumeral ligament lesion, confirmed by arthroscopy. The purpose of this study was to retrospectively investigate pathologies of UPS based on our definitions. We also aimed to assess the outcomes after arthroscopic soft-tissue stabilization for UPS. Methods We reviewed patients who were retrospectively diagnosed as UPS based on our definition and underwent arthroscopic stabilization between January 2007 and September 2018. Patients' demographics, physical and radiographic findings, intraoperative findings, clinical outcomes (Rowe scores, Subjective Shoulder Value [SSV], and the visual analog scale [VAS] for pain), and return to play sport (RTPS) were investigated. Results This study included 91 shoulders in 91 patients with a mean age of 23 years (range, 15-51). The mean follow-up was 37 months (range, 24-156). Eighty-seven patients were involved in sports activities: collision/contact, 55 patients (60%); overhead, 26 patients (29%). The pain was reproduced during the anterior apprehension test in 86 shoulders (95%). Normal type (49%) predominated in glenoid morphology followed by fragment (bony Bankart) type (37%). Most fragment-type lesions were seen in collision/contact athletes. Intraoperative findings demonstrated that Bankart lesions were found in all patients and Hill-Sachs lesions only in 42%. Magnetic resonance arthrography in the abducted and externally rotated positions showed a Bankart lesion in 76 shoulders (84%). Rowe score, SSV, and pain VAS significantly improved postoperatively (P < .001 for each). Forty-two of 70 athletes (60 %) with > 2-year follow-up returned to the sport at a complete or near-preinjury level. Six (9%) athletes experienced reinjury. Conclusion All shoulders that were diagnosed as UPS with our definition had a Bankart lesion. There seemed to be two different types of pathologies: Bankart lesions in lax shoulders and bony Bankart lesions in collision/contact athletes. The pain experienced during the anterior apprehension test may be useful for the diagnosis of UPS. Arthroscopic soft-tissue stabilization yielded good clinical outcomes with a high RTPS rate, but the reinjury rate was relatively high.
Collapse
Affiliation(s)
- Shota Hoshika
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Keisuke Matsuki
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Morihito Tokai
- Tokyo Sports and Orthopaedic Clinic, Toshima, Tokyo, Japan
| | - Takeshi Morioka
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Yusuke Ueda
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Hiroshige Hamada
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Norimasa Takahashi
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | | |
Collapse
|
6
|
Leahy TM, Kenny IC, Campbell MJ, Warrington GD, Cahalan R, Harrison AJ, Lyons M, Glynn LG, O’Sullivan K, Purtill H, Comyns TM. Epidemiology of Shoulder Injuries in Schoolboy Rugby Union in Ireland. Orthop J Sports Med 2021; 9:23259671211023431. [PMID: 34485581 PMCID: PMC8414631 DOI: 10.1177/23259671211023431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The shoulder has been reported as a frequent location of injury in adult professional and amateur rugby, with match injury incidence rates ranging from 1.8 to 3 per 1000 player-hours (h). An increased understanding of the incidence and mechanism of shoulder injuries in school rugby players is vital to establish effective injury preventive strategies and advise on appropriate rehabilitation. PURPOSE To describe the incidence, nature, and severity of shoulder injuries in schoolboy rugby in Ireland. STUDY DESIGN Descriptive epidemiology study. METHODS Injury surveillance was carried out for Senior Cup teams across two seasons (N = 665 players aged 17-19 years) in Ireland from 2018 to 2020. Match and training injury data were recorded using an online system by trained nominated injury recorders. Match exposure was also recorded. RESULTS Shoulder match injury incidence was 12.2 per 1000 h (95% CI, 9.1-16.2), with a mean severity of 47 days' time loss and an overall burden of 573 days per 1000 h. In total, 47 match and 5 training shoulder injuries were recorded. The most common injuries were shoulder dislocations/subluxations (34%), followed by acromioclavicular joint sprains (30%). Shoulder dislocations/subluxations represented the most burdensome injury (280 days per 1000 h). The tackle accounted for the majority (81%) of shoulder injuries. Forwards sustained a significantly higher incidence of shoulder injuries (8.3/1000 h) in comparison with backs (3.9/1000 h), with a rate ratio of 2.13 (95% CI, 1.15-3.94; P = .015). CONCLUSION We found a notably higher injury incidence rate in schoolboy rugby as compared with the adult amateur and professional game. Shoulder injuries were responsible for more days lost than any other injury, and shoulder dislocations were the most severe. This is of particular concern so early in a player's career and warrants further investigation into potential risk factors and mechanisms associated with shoulder injuries in school-age players.
Collapse
Affiliation(s)
- Therese M. Leahy
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Ian C. Kenny
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Mark J. Campbell
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Lero, The Irish Software Research Centre, University of Limerick, Limerick, Ireland
| | - Giles D. Warrington
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Roisin Cahalan
- Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Andrew J. Harrison
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Mark Lyons
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Liam G. Glynn
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Kieran O’Sullivan
- Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Helen Purtill
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Thomas M. Comyns
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
7
|
Teske LG, Arvesen J, Kissenberth MJ, Pill SG, Lutz A, Adams KJ, Thigpen CA, Tokish JM, Momaya A, Shanley E. Athletes diagnosed with anterior and posterior shoulder instability display different chief complaints and disability. J Shoulder Elbow Surg 2021; 30:S21-S26. [PMID: 33895304 DOI: 10.1016/j.jse.2021.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior shoulder instability is a common complaint of young athletes. Posterior instability in this population is less well understood, and the standard of care has not been defined. The purpose of the study is to compare index frequency, treatment choice, and athlete disability following an incident of anterior or posterior shoulder instability in high school and collegiate athletes. METHODS A total of 58 high school and collegiate athletes (n=30 athletes with anterior instability; n=28 athletes with posterior instability) were included. Athletes suffering from a traumatic sport-related shoulder instability episode during a team-sponsored practice or game were identified by their school athletic trainer. Athletes were referred to the sports medicine physician or orthopedic surgeon for diagnosis and initial treatment choice (operative vs. nonoperative). Athletes diagnosed with traumatic anterior or posterior instability who completed the full course of treatment and provided pre- and post-treatment patient-reported outcome measures were included in the study. The frequency of shoulder instability was compared by direction, mechanism of injury (MOI), and treatment choice through χ2 analyses. A repeated measures analysis of variance was used to compare the functional outcomes by treatment type and direction of instability (α = 0.05). RESULTS Athletes diagnosed with anterior instability were more likely to report a chief complaint of instability (70%), whereas those diagnosed with posterior instability reported a primary complaint of pain interfering with function (96%) (P = .001). The primary MOI classified as a contact event was similar between anterior and posterior instability groups (77% vs. 54%, P = .06) as well as the decision to proceed with surgery (60% vs. 72%, P = .31). In patients with nonoperative care, athletes with anterior instability had significantly more initial disability than those with posterior instability (32±6.1 vs. 58±8.1, P = .001). Pre- and post-treatment Penn Shoulder Scores for athletes treated with early surgery were similar (P > .05). There were no differences in functional outcomes at discharge in those treated nonoperatively regardless of direction of instability (P = .24); however, change in Penn score was significantly greater in those with anterior (61±18.7) than those with posterior (27 ± 25.2) instability (P = .002). CONCLUSION Athletes with anterior instability appear to have different mechanisms and complaints than those with posterior instability. Among those that receive nonoperative treatment, athletes with anterior instability have significantly greater initial disability and change in disability than those with posterior disability during course of care.
Collapse
Affiliation(s)
- Lucas G Teske
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA
| | - John Arvesen
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA
| | - Michael J Kissenberth
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA
| | - Stephan G Pill
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA
| | - Adam Lutz
- ATI Physical Therapy, Greenville, SC, USA
| | | | | | | | - Amit Momaya
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | |
Collapse
|
8
|
Olds MK, Lemaster N, Picha K, Walker C, Heebner N, Uhl T. Line Hops and Side Hold Rotation Tests Load Both Anterior and Posterior Shoulder: A Biomechanical Study. Int J Sports Phys Ther 2021; 16:477-487. [PMID: 33842043 PMCID: PMC8016413 DOI: 10.26603/001c.21454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Clinical tests should replicate the stressful positions encountered during sport participation. Evaluating the kinetic and electromyographical demands of clinical tests enables clinicians to choose appropriate tests for specific sports. PURPOSE To describe the shoulder forces and muscle activation levels during closed chain functional tests of Line Hops (LH) and Side Hold Rotation (SHR). STUDY DESIGN Descriptive biomechanical study. METHODS Ten asymptomatic participants were examined in a university laboratory. Two functional tests were evaluated using three-dimensional video analysis and electromyography to measure shoulder forces, moments, and muscular activity levels. RESULTS SHR produced a peak average posterior translation force of 4.84 N/kg (CI95 4.32-5.36N/kg) and a peak average anterior translational force of 1.57 N/kg (CI95 1.10-2.01N/kg). High levels of serratus anterior (98% maximum voluntary isometric contraction (MVIC) and infraspinatus (52 %MVIC) were recorded during SHR. LH produced a posterior translational force of 4.25 N/kg (CI95 3.44-5.06N/kg). High levels of serratus anterior (105 %MVIC) and infraspinatus (87 %MVIC) were recorded during the push off phase of this activity. CONCLUSIONS LH and SHR placed large posterior translational forces that approached half of a person's bodyweight on shoulder structures. SHR produced an anterior translation force at extremes of horizontal abduction placing approximately 18% of bodyweight on shoulder structures. The LH test required the serratus anterior to provide power to push the upper torso of the ground while both the serratus and the infraspinatus provides scapular and humeral stability, respectively. LEVEL OF EVIDENCE 4: Case series.
Collapse
Affiliation(s)
| | | | - Kelsey Picha
- A.T. Still University, Arizona School of Health Sciences
| | | | | | | |
Collapse
|
9
|
Rehabilitation After Shoulder Instability Surgery: Keys for Optimizing Recovery. Sports Med Arthrosc Rev 2020; 28:167-171. [PMID: 33156232 DOI: 10.1097/jsa.0000000000000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The specific approach to rehabilitation after surgical management of the unstable shoulder is dependent on the severity and chronicity of the instability. Establishing dynamic stability throughout the athlete's functional range of movement is critical to a successful outcome. The pace progression is guided by surgical (technique, injury pattern, and strength of repair) and patient factors (healing potential, prior health status, and psychosocial factors). The primary goal of treatment is to restore function and return the athlete to sport. The process should be guided by surpassing functional criteria for progression and tissue healing time.
Collapse
|
10
|
Shanley E, Thigpen C, Brooks J, Hawkins RJ, Momaya A, Kwapisz A, Kissenberth MJ, Tokish JM. Return to Sport as an Outcome Measure for Shoulder Instability: Surprising Findings in Nonoperative Management in a High School Athlete Population. Am J Sports Med 2019; 47:1062-1067. [PMID: 30865844 DOI: 10.1177/0363546519829765] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Young age and contact sports have been postulated as risk factors for anterior shoulder instability. Management after shoulder instability is controversial, with studies suggesting that nonoperative management increases the risk of recurrence. Several studies examined return to play after an in-season instability episode, and few followed these patients to determine if they were able to successfully compete in a subsequent season. No study has evaluated this question in a high school athlete population. PURPOSE To compare the likelihood of return to scholastic sport and complete the next full season without an additional time-loss injury among athletes with anterior shoulder instability in terms of treatment, instability type, and sport classification. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Athletes were included in this study as identified by a scholastic athletic trainer as experiencing a traumatic time-loss anterior shoulder instability injury related to school-sponsored participation. The cohort was predominantly male (n = 108, 84%) and consisted mostly of contact athletes (n = 101, 78%). All athletes had dislocation or subluxation diagnosed by a board-certified physician who determined the athlete's course of care (nonoperative vs operative). Successful treatment was defined as completion of care and return to the athlete's index sport, with full participation for the following season. Chi-square and relative risk analyses were completed to compare success of treatment (nonoperative vs operative care) and instability type. Separate logistic regressions were used to compare the effect of sex and sport classification on the athletes' ability to return to sport. Statistical significance was set a priori as α = .05. RESULTS Scholastic athletes (N = 129) received nonoperative (n = 97) or operative (n = 32) care. Nonoperatively treated (85%) and operatively treated (72%) athletes successfully returned to the same sport without injury for at least 1 full season ( P = .11). Players sustaining a dislocation were significantly more likely to fail to return when compared with those sustaining a subluxation (26% vs 89%, P = .013). Sex ( P = .85) and sport classification ( P = .74) did not influence the athlete's ability to return to sport, regardless of treatment type. CONCLUSION A high percentage of athletes with shoulder instability achieved successful return to sport without missing any additional time for shoulder injury. Those with subluxations were at almost 3 times the odds of a successful return compared with those sustaining a dislocation.
Collapse
Affiliation(s)
- Ellen Shanley
- Center for Effectiveness Research in Orthopaedics, Greenville, South Carolina, USA.,ATI Physical Therapy, Greenville, South Carolina, USA
| | - Charles Thigpen
- Center for Effectiveness Research in Orthopaedics, Greenville, South Carolina, USA.,ATI Physical Therapy, Greenville, South Carolina, USA
| | - John Brooks
- Center for Effectiveness Research in Orthopaedics, Greenville, South Carolina, USA.,Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Richard J Hawkins
- Center for Effectiveness Research in Orthopaedics, Greenville, South Carolina, USA.,Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, USA
| | - Amit Momaya
- Division of Orthopedic Surgery, University of Alabama, Birmingham, Alabama, USA
| | - Adam Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Łódź, Łódź, Poland
| | - Michael J Kissenberth
- Center for Effectiveness Research in Orthopaedics, Greenville, South Carolina, USA.,Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, USA
| | - John M Tokish
- Orthopedic Surgery, Orthopedic Sports Medicine, Mayo Clinic, Phoenix, Arizona, USA
| |
Collapse
|
11
|
Frizziero A, Vittadini F, Del Felice A, Creta D, Ferlito E, Gasparotti R, Masiero S. Conservative treatment after axillary nerve re-injury in a rugby player: a case report. Eur J Phys Rehabil Med 2018; 55:510-514. [PMID: 30574734 DOI: 10.23736/s1973-9087.18.05165-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Axillary nerve injuries are uncommon, although the incidence is higher in athletes, both related to direct contusion or quadrilateral space syndrome. While few studies have investigated conservative strategies that could be proposed to avoid surgery, no previous case report documented the possible role of rehabilitation in axillary nerve reinjuries. Our patient is a 27-year-old male professional rugby player who experienced a recurrent episode of deltoid strength loss, after a previous axillary nerve injury. The MRI of the brachial plexus showed increased signal intensity of C5 spinal root, together with denervation edema in infraspinatus muscle, related to a recent traction injury while the EMG confirmed the persistence of traumatic paresis of axillary nerve and the chronic sufferance of C5 myotome. Our conservative treatment consists in a 2-phases rehabilitation protocol builded up on the basis of a shoulder kinematic test, electrostimulation test and a further EMG. The purpose of this report was to bring attention on axillary nerve conservative management. Premature return to sport may predispose the patient to the risk of re-injury. A prompt diagnosis and a timely specific rehabilitation protocol allow to a safe full-return to professional sport activity and may prevent recurrences.
Collapse
Affiliation(s)
- Antonio Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padua, Padua, Italy -
| | - Filippo Vittadini
- Department of Physical and Rehabilitation Medicine, University of Padua, Padua, Italy.,Venezia Football Club Medical Staff, Venice, Italy
| | - Alessandra Del Felice
- Department of Physical and Rehabilitation Medicine, University of Padua, Padua, Italy
| | - Domenico Creta
- Hospital "Casa di Cura Santa Maria Maddalena" Occhiobello, Rovigo, Italy
| | - Erika Ferlito
- Department of Physical and Rehabilitation Medicine, University of Padua, Padua, Italy
| | - Roberto Gasparotti
- Section of Neuroradiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Masiero
- Department of Physical and Rehabilitation Medicine, University of Padua, Padua, Italy
| |
Collapse
|
12
|
Baverel L, Colle PE, Saffarini M, Anthony Odri G, Barth J. Open Latarjet Procedures Produce Better Outcomes in Competitive Athletes Compared With Recreational Athletes: A Clinical Comparative Study of 106 Athletes Aged Under 30 Years. Am J Sports Med 2018; 46:1408-1415. [PMID: 29589955 DOI: 10.1177/0363546518759730] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In cases of shoulder stabilization for anterior instability, the main goals of the surgery are a rapid and efficient return to sports and excellent long-term outcomes without recurrence of dislocation, particularly in young and competitive athletes. PURPOSE To determine whether outcomes of open Latarjet procedure (OLPs) depend on the level of sports practiced by patients and to report clinical scores and complication rates for OLP at a minimum follow-up of 2 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective comparative study was conducted for all patients who underwent OLP by the senior author (J.B.) between July 2007 and December 2012. The indication for OLP at the authors' institution was a minimum of 2 episodes of dislocation and/or subluxation, a positive apprehension test result in the cocking position, an Instability Severity Index Score more than 2, and evidence of anterior instability lesions on computed tomography arthrograms. The 106 included patients (110 shoulders) with a mean follow-up of 46 months were compared in 2 groups depending on sport activities: 57 (54%) competitive athletes and 49 (46%) recreational athletes. The principal outcome measure was evidence of recurrent instability. The secondary outcome measures were clinical scores related to anterior instability and related to sport practice: Rowe score, Oxford Shoulder Instability Score (OSIS), Western Ontario Shoulder Instability Index, and level of satisfaction. RESULTS Of the 106 patients, 3 reported recurrence of shoulder dislocation: 2 competitive athletes (3.5%; 95% CI, 0.9%-11.2%) and 1 recreational athlete (2%; 95% CI, 0.4%-10.7%) ( P = .684). The persistent apprehension test result was positive in 7 competitive athletes (11.5%) and in 5 recreational athletes (10%) ( P = .566). The Rowe scores improved from 56.3 ± 13.2 (range, 30-80) preoperatively to 84.2 ± 16.4 (range, 30-100) postoperatively in competitive athletes and from 55.0 ± 11.0 (range, 35-80) to 69.5 ± 22.0 (range, 15-100) in recreational athletes ( P < .001). The net improvement in Rowe scores was significantly greater in competitive athletes (27.9 ± 21.7) compared with recreational athletes (14.5 ± 24.4) ( P = .006). The scores unrelated to sport activity (Oxford Shoulder Instability Score and Simple Shoulder Test) were similar for the 2 groups. All 57 (100%) competitive athletes and 34 (69.4%) recreational athletes resumed their previous sports practice, at the same level or higher than before their injury (respectively, 78.9% and 42.9%; P = .004). CONCLUSION The OLP could be considered for primary shoulder stabilization, particularly in competitive athletes, who have high functional demands and great risks of redislocation.
Collapse
Affiliation(s)
- Laurent Baverel
- Department of Shoulder Surgery, Centre Hospitalier Privé, Saint-Grégoire, France
| | | | - Mo Saffarini
- Medical Technology, ReSurg SA, Nyon, Switzerland
| | - Guillaume Anthony Odri
- Orthopaedic and Traumatologic Department, Lariboisière University Hospital, Paris, France
| | - Johannes Barth
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres Parc Sud Galaxie, Echirolles, Grenoble, France
| |
Collapse
|
13
|
Paulino Pereira NR, van der Linde JA, Alkaduhimi H, Longo UG, van den Bekerom MPJ. Are collision athletes at a higher risk of re-dislocation after an open Bristow-Latarjet procedure? A systematic review and meta-analysis. Shoulder Elbow 2018; 10:75-86. [PMID: 29560032 PMCID: PMC5851127 DOI: 10.1177/1758573217728290] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/09/2017] [Accepted: 08/03/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND The primary aim of the present study was to review, summarize and compare the redislocation risk for collision athletes and noncollision athletes after an open Bristow-Latarjet procedure. Our secondary aim was to summarize return to sport, satisfaction, pain and complications. METHODS We conducted a systematic review in PubMed and EMBASE of articles until 1 July 2016. We included all studies describing Bristow-Latarjet like procedures as a result of glenohumeral instability, mentioning redislocation rates in collision athletes with >2 years of follow-up. We pooled the data using random-effects meta-analysis for redislocation risk-differences (RD) between collision and noncollision athletes, and assessed heterogeneity with I2 and Tau2 tests. RESULTS From 475 titles and abstracts, 11 studies were included and eight studies were meta-analyzed. The pooled RD to develop a postoperative redislocation between collision athletes and noncollision athletes was -0.00 (95% confidence interval: -0.03 to 0.03, p = 0.370). Return to sports rates were high (67-100%), and patients reported high satisfaction scores (93-100% satisfied) and low pain scores (mean visual analogue scale score of 1.6); however, postoperative complication rates varied from 0.8% to 19.2%. CONCLUSIONS Collision athletes are not more at risk for redislocation rates after an open Bristow-Latarjet procedure compared to noncollision athletes. Overall postoperative outcomes were good, although numerous complications occurred.
Collapse
Affiliation(s)
- Nuno Rui Paulino Pereira
- Massachusetts General Hospital, Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Just A. van der Linde
- Onze lieve Vrouwe Gasthuis Amsterdam, Orthopaedic Research Center, Amsterdam, The Netherlands
| | - Hassanin Alkaduhimi
- Onze lieve Vrouwe Gasthuis Amsterdam, Orthopaedic Research Center, Amsterdam, The Netherlands,Hassanin Alkaduhimi, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
| | - Umile Giuseppe Longo
- Campus Bio-Medico University, Department of Orthopaedic and Trauma Surgery, Rome, Italy
| | | |
Collapse
|
14
|
Ranalletta M, Rossi LA, Bertona A, Tanoira I, Hidalgo IA, Maignon GD, Bongiovanni SL. Modified Latarjet Without Capsulolabral Repair in Rugby Players With Recurrent Anterior Glenohumeral Instability and Significant Glenoid Bone Loss. Am J Sports Med 2018; 46:795-800. [PMID: 29320219 DOI: 10.1177/0363546517749586] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The optimal management of recurrent anterior shoulder instability with significant glenoid bone loss in high-demand collision athletes remains a challenge. PURPOSE To analyze the time to return to sport, clinical outcomes, and recurrences following a modified Latarjet procedure without capsulolabral repair in rugby players with recurrent anterior shoulder instability and significant glenoid bone loss. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between June 2008 and June 2015, 50 competitive rugby players (practice >2 times per week and competition during weekends) with recurrent anterior shoulder instability underwent operation with the modified congruent arc Latarjet procedure without capsulolabral repair in our institution. Cases included 18 primary repairs and 32 revisions. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale for pain in sport activity (VAS), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. The final analysis included 49 shoulders in 48 patients (31 revision cases). RESULTS The mean follow-up was 48 months (range, 24-108 months) and the mean age at the time of operation was 22.8 years (range, 17-35 years). Forty-five patients (93.7%) returned to playing rugby, all at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistically significant improvement after operation ( P < .001). The Rowe score increased from a mean of 39.5 points preoperatively to 94 points postoperatively ( P < .01). The VAS score decreased from 3.6 points preoperatively to 1.2 points postoperatively ( P < .01). The ASOSS score improved significantly from a mean of 44 points preoperatively to 89.5 points postoperatively ( P < .01). No recurrence of shoulder dislocation or subluxation was noted. The bone block healed in 43 shoulders (88%). CONCLUSION In rugby players with recurrent anterior shoulder instability and significant glenoid bone loss, the modified Latarjet procedure without capsulolabral repair produced excellent functional outcomes, with most athletes returning to rugby at their preinjury level of play without recurrences.
Collapse
Affiliation(s)
- Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
| | - Luciano A Rossi
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
| | - Agustin Bertona
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
| | - Ignacio Tanoira
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
| | - Ignacio Alonso Hidalgo
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
| | - Gastón D Maignon
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
| | - Santiago L Bongiovanni
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
| |
Collapse
|
15
|
Patients' expectations of shoulder instability repair. Knee Surg Sports Traumatol Arthrosc 2018; 26:15-23. [PMID: 28289818 DOI: 10.1007/s00167-017-4489-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To analyze and compare patient expectations of primary and revision shoulder stabilization and to assess the factors associated with patients' expectations. METHODS Pre-operative patient expectations after shoulder instability repair were prospectively assessed using a self-designed questionnaire. The survey included questions on the expected level and type of return to sports, instability, pain, risk of osteoarthritis, and overall shoulder condition. RESULTS One-hundred and forty-five patients (99 primary; 46 revision repair) were included. A return to sport at the same level with slight to no restrictions was expected in 95%, a return to high-risk activities in 34%, to moderate in 58%, and to low-risk activities in 9%. No pain [instability] independent of the activity level was expected by 71% [79%] and occasional pain [instability] during contact and overhead activities by 25% [19%]. 61% expected to have no risk of glenohumeral osteoarthritis, 37% a slight, and 2% a significant risk. The overall expectation for the post-operative shoulder was indicated to be normal or nearly normal in 99% of patients. The revision group did not differ from the primary repair group in any variable. High pre-operative sport performance was positively correlated with post-operative sport expectations. The number of dislocations, the duration of instability, and the subjective instability level were negatively correlated with return to sport expectations. CONCLUSION Patient expectations for primary and revision shoulder instability repair are high. Realistic patient expectations regarding the surgical procedure are necessary to avoid low patient satisfaction, especially in pre-operatively highly active and demanding athletes. The surgeon must not solely base the treatment on the pathology and possible risk factors for failure but should also take the individual expectation of the patient into account. LEVEL OF EVIDENCE III.
Collapse
|
16
|
Return to play after shoulder instability in National Football League athletes. J Shoulder Elbow Surg 2018; 27:17-22. [PMID: 28941971 DOI: 10.1016/j.jse.2017.07.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/16/2017] [Accepted: 07/28/2017] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We hypothesized that National Football League (NFL) players sustaining a shoulder destabilizing injury could return to play (RTP) successfully at a high rate regardless of treatment type. METHODS We identified and evaluated 83 NFL players who sustained an in-season shoulder instability event while playing in the NFL. NFL RTP, incidence of surgery, time to RTP, recurrent instability events, seasons/games played after the injury, and demographic data were collected. Overall RTP was determined, and players who did and did not undergo operative repair were compared. RESULTS Ninety-two percent of NFL players returned to NFL regular season play at a median of 0.0 weeks in those sustaining a shoulder subluxation and 3.0 weeks in those sustaining a dislocation who did not undergo surgical repair (P = .029). Players who underwent operative repair returned to play at a median of 39.3 weeks. Forty-seven percent of players had a recurrent instability event. For players who were able to RTP, those who underwent surgical repair (31%) had a lower recurrence rate (26% vs. 55%, P = .021) and longer interval between a recurrent instability event after RTP (14.7 vs. 2.5 weeks, P = .050). CONCLUSION There is a high rate of RTP after shoulder instability events in NFL players. Players who sustain shoulder subluxations RTP faster but are more likely to experience recurrent instability than those with shoulder dislocations. Surgical stabilization of the shoulder after an instability event decreases the chances of a second instability event and affords a player a greater interval between the initial injury and a recurrent event.
Collapse
|