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Casper PC, Benedict T, Morris J, McHenry P, Dummar M, Crowell MS. Are Psychological Variables and Time Since Surgery Related to Rotator Cuff Strength and Functional Performance in Cadets After Shoulder Stabilization Surgery? Sports Health 2024:19417381241270360. [PMID: 39192776 DOI: 10.1177/19417381241270360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Traumatic shoulder instability is a common injury in the general population and the military. Surgical stabilization surgery reduces recurrence rates compared with nonsurgical management. Time since surgery is generally the primary measure of return to sport. There is a gap in knowledge on psychological variables and time since surgery and their relationship to rotator cuff strength and functional performance. HYPOTHESIS It was hypothesized that, after shoulder stabilization surgery, psychological factors and time since surgery will be associated positively with objective physical performance tests, that physical performance will differ significantly between postsurgery cadets and healthy controls, and that surgical stabilization of the nondominant arm will demonstrate greater range of motion deficits than surgical intervention on the dominant arm. STUDY DESIGN Case-control study. LEVEL OF EVIDENCE Level 4. METHODS The 52 participants (26 postsurgical [6-24 months after surgery] and 26 healthy controls) were all military cadets. Outcome measures were patient-reported outcomes, range of motion, isometric strength, and functional performance. RESULTS No significant relationships existed between time since surgery and psychological factors to rotator cuff strength or functional performance. Significant differences were found between groups in self-reported outcomes, including the Shoulder Instability Return to Sport After Injury scale, Single Assessment Numeric Evaluation, Numeric Pain Rating Scale, quickDASH, flexion and external rotation (ER), and ER limb symmetry. Those who received dominant-sided shoulder surgery demonstrated a greater mean active range of motion deficit than those who received nondominant-sided surgery. Both groups demonstrated a significant loss in ER, but dominant-sided surgical participants also demonstrated significant flexion loss. CONCLUSION Time since surgery and psychological variables did not demonstrate a relationship to rotator cuff strength and functional performance. Significant differences existed between the stabilization surgical participants and healthy controls in all patient-reported outcomes. Surgical participants with dominant-sided shoulder surgery demonstrated a greater mean motion deficit when compared with those who received nondominant-sided surgery.
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Affiliation(s)
- Preston C Casper
- Baylor University - Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, United States Military Academy, West Point, New York
| | - Timothy Benedict
- Baylor University - Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, United States Military Academy, West Point, New York
| | - Jamie Morris
- Baylor University - Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, United States Military Academy, West Point, New York
| | - Paige McHenry
- Baylor University - Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, United States Military Academy, West Point, New York
| | - Max Dummar
- Baylor University - Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, United States Military Academy, West Point, New York
| | - Michael S Crowell
- Baylor University - Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, United States Military Academy, West Point, New York
- University of Scranton, Scranton, Pennsylvania
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Corban J, Shah S, Ramappa AJ. Current Evidence Based Recommendations on Rehabilitation following Arthroscopic Shoulder Surgery: Rotator Cuff, Instability, Superior Labral Pathology, and Adhesive Capsulitis. Curr Rev Musculoskelet Med 2024; 17:247-257. [PMID: 38668940 PMCID: PMC11156828 DOI: 10.1007/s12178-024-09899-7] [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] [Accepted: 04/17/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Arthroscopy has become increasingly popular for a addressing a wide variety of shoulder pathology. However, despite increasing interest, there is still much uncertainty and variability amongst providers regarding optimal post-operative rehabilitation. This review provides an overview of the evidence underlying common rehab protocols used following arthroscopic interventions for rotator cuff disease, shoulder instability, superior labral anterior to posterior (SLAP) tears and adhesive capsulitis. RECENT FINDINGS For small and medium sized rotator cuff tears, early motion protocols do not seem to affect healing or retear rates, however there is no difference with regards to long term functional outcomes when compared to standard motion protocols. For larger tears (> 3 cm), early active motion may be associated with impaired tendon integrity. Early range of motion following arthroscopic Bankart repair has not been shown to increase rate of recurrence, however the data on return to sport requires more granularity to effectively guide care. Further research needs to be done to compare rehab protocols following SLAP repair and arthroscopic capsular release. Rehabilitation protocols following rotator cuff surgery and anterior shoulder stabilization have garnered the most research interest. However, there is still a need for larger higher-level studies examining the long-term effects of different rehab protocols. Regarding the arthroscopic management of other types of shoulder instability, SLAP tears and adhesive capsulitis, there is paucity of high-quality evidence. This knowledge gap likely underpins the variability in different rehab protocols seen in clinical practice, highlighting the need for more research.
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Affiliation(s)
| | - Sarav Shah
- New England Baptist Hospital, Boston, MA, USA
| | - Arun J Ramappa
- New England Baptist Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Yildiz TI, Turhan E, Huri G, Ocguder DA, Duzgun I. Cross-education effects on shoulder rotator muscle strength and function after shoulder stabilization surgery: a randomized controlled trial. J Shoulder Elbow Surg 2024; 33:804-814. [PMID: 38122890 DOI: 10.1016/j.jse.2023.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
Abstract
HYPOTHESIS This study aimed to investigate the effects of cross education (CE) on rotator cuff (RC) muscle strength recovery and shoulder function in patients who underwent arthroscopic anterior shoulder stabilization surgery. METHODS Twenty-eight patients who underwent shoulder stabilization surgery were included in the study (age, 25 ± 6 years; body mass index, 24.8 ± 3.6 kg/m2). The patients were randomly divided into either the CE group (n = 14) or the control group (n = 14). All patients received a standardized rehabilitation program until the end of the 12th postoperative week. The CE group also received isokinetic training of the nonoperative shoulder focusing on the RC muscles (twice a week, 3 sets of 10 repetitions). RC muscle strength was measured preoperatively and at 3 and 6 months postoperatively using an isokinetic dynamometer at 60°/s and 180°/s angular velocities. Shoulder function was assessed with the Closed Kinetic Chain Upper Extremity Stability Test and Y-Balance Test-Upper Quarter. Analyses of covariance were used for the statistical analyses. RESULTS At 6 months postoperatively, at 60°/s angular velocity, there was higher internal rotator strength in the CE group (P = .02) and similar external rotator strength (P = .62) between the groups. At 180°/s angular velocity, both internal rotator strength (P = .04) and external rotator strength (P = .02) were higher in the CE group. The Closed Kinetic Chain Upper Extremity Stability Test (P = .47), Y-Balance Test-Upper Quarter (P = .95), and Western Ontario Shoulder Instability Index (P = .12) scores were similar between the groups at 6 months after surgery. CONCLUSIONS CE in the early period of postoperative rehabilitation following stabilization surgery improves RC strength recovery. However, it has no effect on functional outcomes. Integrating a CE program into the postoperative rehabilitation protocol may help to improve dynamic shoulder stability but not functional capacity.
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Affiliation(s)
- Taha Ibrahim Yildiz
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Egemen Turhan
- Department of Orthopedy and Traumatology, Hacettepe University, Ankara, Turkey
| | - Gazi Huri
- Department of Orthopedy and Traumatology, Hacettepe University, Ankara, Turkey
| | - Durmus Ali Ocguder
- Department of Orthopedy and Traumatology, Ankara Sehir Hastanesi, Ankara, Turkey
| | - Irem Duzgun
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Cleary BP, Hurley ET, Kilkenny CJ, Robinson J, Khan SU, Davey MS, Anakwenze O, Klifto CS, Mullett H. Return to Play After Surgical Treatment for Acromioclavicular Joint Dislocation: A Systematic Review. Am J Sports Med 2024; 52:1350-1356. [PMID: 37345238 DOI: 10.1177/03635465231178784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Acromioclavicular (AC) joint dislocation is a common clinical problem among young and athletic populations. Surgical management is widely used for high-grade dislocations (Rockwood III-VI) and in high-demand athletes at high risk of recurrence. PURPOSE To systematically review the evidence in the literature to ascertain the rate and timing of return to play (RTP) and the availability of specific criteria for safe RTP after surgical treatment for AC joint dislocation. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted in the PubMed database. Clinical studies were eligible for inclusion if they reported on RTP after surgical treatment for AC joint dislocation. Statistical analysis was performed with SPSS. RESULTS We found 120 studies including 4327 cases meeting our inclusion criteria. The majority of patients were male (80.2%), with a mean age of 37.2 years (range, 15-85) and a mean follow-up of 34.5 months. Most were recreational athletes (79%), and the most common sport was cycling. The overall rate of RTP was 91.5%, with 85.6% returning to the same level of play. Among collision athletes, the rate of RTP was 97.3%, with 97.2% returning to the same level of play. In overhead athletes, the rate of RTP was 97.1%, with 79.2% returning to the same level of play. The mean time to RTP was 5.7 months (range, 1.5-15). Specific RTP criteria were reported in the majority of the studies (83.3%); time to return to play was the most commonly reported item (83.3%). Type III Rockwood injuries had the highest RTP rate at 98.7% and the earliest RTP at 4.9 months. Among the different surgical techniques, Kirschner wire fixation had the highest rate of RTP at 98.5%, while isolated graft reconstruction had the earliest RTP at 3.6 months. CONCLUSION The overall rate of RTP was reportedly high after surgical treatment for AC joint dislocation, with the majority of patients returning to their preinjury levels of sport. There is a lack of consensus in the literature for what constitutes a safe RTP, with further focus on this topic required in future studies.
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Affiliation(s)
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland
- Duke University, Durham, North Carolina, USA
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George A, Holderread BM, Phelps BM, Erwin ER, Singer W, Jack RA. Rehabilitation and return to sport criteria following surgical treatment of osteochondritis dissecans of the capitellum: a systematic review. JSES Int 2024; 8:355-360. [PMID: 38464452 PMCID: PMC10920138 DOI: 10.1016/j.jseint.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background Osteochondritis dissecans (OCD) of the capitellum is a well-described condition that most commonly affects adolescent throwing athletes and gymnasts. There is no gold standard rehabilitation protocol or timing for return to sport (RTS) after surgical management of OCD of the capitellum. Hypothesis/Purpose The purpose of the study was to identify in the existing literature any criteria used for RTS following surgical treatment of OCD of the capitellum. The hypothesis was that surgeons would utilize length of time rather than functional criteria or performance benchmarks for RTS. Methods Level 1 to 4 studies evaluating athletes who underwent surgery for OCD of the capitellum with a minimum follow-up of 1-year were included. Studies not describing RTS criteria, including less than 1-year follow-up, non-operative management only, and revision procedures were excluded. Each study was analyzed for RTS criteria, RTS rate, RTS timeline, sport played, level of competition, graft source (if utilized), and postoperative rehabilitation parameters. Assessment of bias and methodological quality was performed using the Coleman methodology score and RTS value assessment. Results All studies reported a rehabilitation protocol with immobilization followed by bracing with progressive range of motion. RTS rate was 80.9% (233/288). The majority of studies reported using time-based criteria for RTS (11/15). The most commonly reported timeline was 6 months (range: 3-12 months). Conclusion The overall RTS rate after surgical treatment of capitellar OCD is high with no consensus on RTS criteria. The two most consistent RTS criteria reported in the literature are return of elbow range of motion and healing demonstrated on postoperative imaging. There is a wide range of time to RTS in the literature, which may be sport dependent. Further research is needed to develop functional and performance-based metrics to better standardize RTS criteria and rehabilitation protocols.
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Affiliation(s)
- Andrew George
- Houston Methodist Orthopedics & Sports Medicine Houston, Houston, TX, USA
| | | | - Brian M Phelps
- Houston Methodist Orthopedics & Sports Medicine Houston, Houston, TX, USA
| | - Emily R Erwin
- Houston Methodist Orthopedics & Sports Medicine Houston, Houston, TX, USA
| | - William Singer
- Houston Methodist Orthopedics & Sports Medicine Houston, Houston, TX, USA
| | - Robert A Jack
- Houston Methodist Orthopedics & Sports Medicine Houston, Houston, TX, USA
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Hurley ET, Lunn K, Bethell M, Levin J, Pasqualini I, Frangiamore S, Anakwenze O, Klifto CS. Return to play following operative management of anterior shoulder instability in overhead athletes-A systematic review. Shoulder Elbow 2024; 16:15-23. [PMID: 38435042 PMCID: PMC10902415 DOI: 10.1177/17585732231205175] [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: 06/26/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 03/05/2024]
Abstract
Background The purpose of this study was to systematically review the rate and timing of return to play in overhead athletes following operative management of anterior shoulder instability. Methods A systematic literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to play among overhead athletes following arthroscopic Bankart repair, open Latarjet procedure or Remplissage procedure. Results There are 23 studies included with 961 patients. Among those undergoing arthroscopic Bankart repair, the rate of return to play was 86.2%, with 70.6% returning to the same level of play and the mean time to return to play was 7.1 months. Among those undergoing an open Latarjet procedure, the rate of return to play was 80.9%, with 77.7% returning to the same level of play and the mean time to return to play was 5.1 months. Among those undergoing a Remplissage procedure, the rate of return to play was 70.6%, with 70.0% returning to the same level of play or mean time to return to play. Discussion Overall, there were high rates of return to play following operative management of anterior shoulder instability in overhead athletes.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Kiera Lunn
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Jay Levin
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | | | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Rabin A, Chechik O, Olds MK, Uhl TL, Kazum E, Deutsch A, Citron E, Cohen T, Dolkart O, Bibas A, Maman E. The supine moving apprehension test-Reliability and validity among healthy individuals and patients with anterior shoulder instability. Shoulder Elbow 2024; 16:98-105. [PMID: 38435037 PMCID: PMC10902411 DOI: 10.1177/17585732231170197] [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: 11/21/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/05/2024]
Abstract
Background Performance-based tests for patients with anterior shoulder dislocation are lacking. This study determined the reliability and validity of the supine moving apprehension test designed to assess the ability to control anterior instability loads. Methods Thirty-six participants were recruited (18 healthy individuals, and 18 patients following anterior shoulder dislocation). Healthy participants performed the supine moving apprehension test on 2 separate occasions to determine test-retest reliability. Patients completed the supine moving apprehension test and the Western Ontario Shoulder Instability index before and 6 months after surgical stabilization of their shoulder. The presence of anterior apprehension was also documented post-operatively. Results The supine moving apprehension test demonstrated good test-retest reliability (intraclass correlation coefficient = 0.74-0.84). Patients performed 18-30 repetitions less than healthy individuals during the supine moving apprehension test (P < 0.01). A strong correlation was found between supine moving apprehension test scores and Western Ontario Shoulder Instability post-operatively (r = -0.74, P ≤ 0.01). Supine moving apprehension test scores significantly improved among patients following surgery (P < 0.01). Patients with a negative apprehension test post-operatively performed the supine moving apprehension test significantly better than patients with a positive apprehension test (P < 0.01). Conclusions The supine moving apprehension test is reliable and valid among patients with anterior shoulder dislocation and may serve to assess patients' ability to control shoulder anterior instability loads.
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Affiliation(s)
- Alon Rabin
- Department of Physical Therapy, Ariel University, Ariel, Israel
| | - Ofir Chechik
- Department of Orthopaedic Surgery, Shoulder Surgery Unit, Tel-Aviv Medical Center, Tel-Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Timothy L Uhl
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Efi Kazum
- Department of Physical Therapy, Ariel University, Ariel, Israel
| | - Adin Deutsch
- Department of Physical Therapy, Ariel University, Ariel, Israel
| | - Eran Citron
- Department of Physical Therapy, Ariel University, Ariel, Israel
| | - Tal Cohen
- Department of Physical Therapy, Ariel University, Ariel, Israel
| | | | - Assaf Bibas
- Department of Orthopaedic Surgery, Shoulder Surgery Unit, Tel-Aviv Medical Center, Tel-Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Maman
- Department of Orthopaedic Surgery, Shoulder Surgery Unit, Tel-Aviv Medical Center, Tel-Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Hemstock R, Sommer M, McRae S, MacDonald P, Woodmass J, Ogborn D. Characterizing the Practices of Canadian Orthopedic Surgeons in the Management of patients With Anterior Glenohumeral Instability. Clin J Sport Med 2023; 33:611-617. [PMID: 37185225 DOI: 10.1097/jsm.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To determine the practice patterns of Canadian orthopedic surgeons in the management of patients with anterior glenohumeral instability (AGHI). DESIGN Cross-sectional survey. SETTING Canada. PATIENTS OR OTHER PARTICIPANTS Canadian orthopedic surgeons with membership in the Canadian Orthopedic Association or Canadian Shoulder and Elbow Surgeon group who had managed at least 1 patient with AGHI in the previous year. INTERVENTIONS A survey including demographics and questions on the management of patients with AGHI was completed. Statistical comparisons (χ 2 ) were completed with responses stratified using the instability severity index score (ISIS) in practice, years of practice, and surgical volumes. MAIN OUTCOME MEASURES Summary statistics were compiled, and response frequencies were considered for consensus (75%). Case series responses were stratified on use of the ISIS in practice, years of experience, and annual procedure volumes (χ 2 , P < 0.05). RESULTS Eighty orthopedic surgeons responded, with consensus on areas of diagnostic workup of AGHI, nonoperative management, and operative techniques. There was no consensus on indications for soft tissue and bony augmentation or postoperative management. There was no difference in practices based on the use of ISIS, years in practice, or surgical volumes. CONCLUSIONS Canadian orthopedic surgeons manage AGHI consistently with consensus achieved in preoperative diagnostics and operative techniques, although debate remains as to the indications for soft tissue and bony augmentation procedures.
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Affiliation(s)
- Riley Hemstock
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
| | - Micah Sommer
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Sheila McRae
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Peter MacDonald
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
| | - Jarret Woodmass
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
| | - Dan Ogborn
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
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Riemann BL, Wilk KE, Davies GJ. Reliability of Upper Extremity Functional Performance Tests for Overhead Sports Activities. Int J Sports Phys Ther 2023; V18:687-697. [PMID: 37425106 PMCID: PMC10324288 DOI: 10.26603/001c.74368] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/26/2023] [Indexed: 07/11/2023] Open
Abstract
Background There is lack of consensus on which tests, particularly upper extremity functional performance tests (FPT) that should be used for clinical decision making to progress a patient through a rehabilitation program or criteria for return to sport (RTS). Consequently, there is a need for tests with good psychometric properties that can be administered with minimal equipment and time. Purpose (1) To establish the intersession reliability of several open kinetic chain FPT in healthy young adults with a history of overhead sport participation. (2) To examine the intersession reliability of the limb symmetry indices (LSI) from each test. Study Design Test-retest reliability, single cohort study. Methods Forty adults (20 males, 20 females) completed four upper extremity FPT during two data collection sessions three to seven days apart: 1) prone medicine ball drop test 90°shoulder abduction (PMBDT 90°), 2) prone medicine ball drop test 90°shoulder abduction/90° elbow flexion (PMBDT 90°-90°), 3) half-kneeling medicine ball rebound test (HKMBRT), 4) seated single arm shot put test (SSASPT). Measures of systematic bias, absolute reliability and relative reliability were computed between the sessions for both the original test scores and LSI. Results Except for the SSASPT, all tests demonstrated significant (p ≤ 0.030) improvements in performance during the second session. Generally, for the medicine ball drop/rebound tests, the absolute reliability was the highest (less random error) for the HKMBRT, next the PMBDT 90°followed by PMBDT 90°-90°. Excellent relative reliability existed for the PMBDT 90°, HKMBRT, and SSASPT, whereas fair to excellent relative reliability for the PMBDT 90°-90°. The SSASPT LSI revealed the highest relative and absolute reliability. Conclusion Two tests, HKMBRT and SSASPT demonstrated sufficient reliability; therefore, the authors' recommend those tests can be used for serial assessments to advance a patient through a rehabilitation program as well as criteria for progression to RTS. Level of Evidence 3.
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Barber P, Pontillo M, Bellm E, Davies G. Objective and subjective measures to guide upper extremity return to sport testing: A modified Delphi survey. Phys Ther Sport 2023; 62:17-24. [PMID: 37300969 DOI: 10.1016/j.ptsp.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To identify which subjective and objective tests do content experts utilize to help guide return to sport (RTS) decision making for an athlete after an upper extremity (UE) injury? METHODS A modified Delphi survey was utilized, including content experts in UE rehabilitation. Survey items were identified based on a literature review identifying current best evidence and practice for UE RTS decision making. Content experts (n = 52) were identified, having a minimum of 10 years of experience with rehabilitation of UE athletic injuries, and 5 years of experience using an UE RTS algorithm to guide decision making. RESULTS Expert consensus was achieved on a combination of tests utilized within an UE RTS algorithm: 1. Tissue healing time frame is an important consideration in RTS decision making; 2. Patient reported outcome measures should be utilized specifically, DASH and NPRS 3. Strength is measured by handheld dynamometer and is an important consideration. 4. ROM should be utilized and is an important consideration. 5. Physical performance tests utilized include: Closed Kinetic Chain Upper Extremity Stability test, Seated shot-put test and lower extremity/core tests. CONCLUSIONS This survey reached expert consensus on which subjective and objective measures to utilize to evaluate RTS readiness after UE injury.
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Affiliation(s)
- Patrick Barber
- University of Rochester Medical Center, Rochester, NY, USA.
| | | | - Eric Bellm
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - George Davies
- Georgia Southern University Physical Therapy Program, Savannah, GA, USA.
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Rogowski I, Nové-Josserand L, Godenèche A, Colotte P, Franger G, Vigne G, Vieira TD, Blache Y, Neyton L. Functional Deficits After Open Latarjet Procedure and Dominance of the Operated Shoulder: An Analysis of 133 Patients. Am J Sports Med 2023; 51:1277-1285. [PMID: 36847281 DOI: 10.1177/03635465231156181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Return to sport after stabilization surgery using the open Latarjet procedure remains challenging. Additional knowledge is needed about postoperative shoulder functional deficits in order to better design return-to-sport programs. PURPOSE To investigate the effects of the dominance status of the operated shoulder on the shoulder functional profile recovery at 4.5 months after open Latarjet procedure. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A retrospective analysis of prospectively collected data was performed. All patients who underwent the open Latarjet procedure between December 2017 and February 2021 were eligible for the study. Functional assessment at 4.5 months after the surgery was performed using the following tests: maximal voluntary isometric contractions in glenohumeral internal and external rotation, upper-quarter Y balance test, unilateral seated shot-put test, and modified closed kinetic chain upper extremity stability test, leading to 10 outcome measures. Patients whose dominant side had undergone surgery and those whose nondominant side had undergone surgery were compared with a group of 68 healthy control participants. RESULTS A total of 72 patients who underwent an open Latarjet procedure on the dominant side and 61 patients who underwent open Latarjet on the nondominant side were compared with 68 healthy control athletes. In patients whose dominant shoulder had undergone surgery, significant deficits for the dominant side (P < .001) and for the nondominant side (P < .001) were found in 9 of 10 functional outcome measures. Among patients whose operations were on the nondominant shoulder, significant deficits for the nondominant side (P < .001) and for the dominant side (P < .001) were found in 9 and 5 of the 10 functional outcome measures, respectively. CONCLUSION Regardless of dominance of the stabilized shoulder, persistent deficits in strength, stability, mobility, power, and stroke frequency were observed at 4.5 months postoperatively. Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides. However, stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder. REGISTRATION NCT05150379 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Isabelle Rogowski
- Université de Lyon, Université Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité-EA 7424, Villeurbanne Cedex, France
| | - Laurent Nové-Josserand
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | - Arnaud Godenèche
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | - Philippe Colotte
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | - Gabriel Franger
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | | | - Thais Dutra Vieira
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | - Yoann Blache
- Université de Lyon, Université Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité-EA 7424, Villeurbanne Cedex, France
| | - Lionel Neyton
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
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Hill JR, Motley J, Keener JD. Rehabilitation after Shoulder Instability Surgery. Phys Med Rehabil Clin N Am 2023; 34:409-425. [PMID: 37003661 DOI: 10.1016/j.pmr.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Shoulder instability can occur in any direction and presents across a broad spectrum including traumatic dislocations, repetitive microinstability events or subluxations, and global joint laxity. The development of pain, functional decline, and articular pathologic condition is a multifaceted process that is influenced by the underlying bony morphology, biology of the surrounding soft tissue structures, dynamic coordination of the periscapular musculature, and patient factors such as age, activity level, and associated injuries. This article will focus on the younger, active patient with instability due to deficiencies in the capsulolabral complex and dynamic stabilizers.
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13
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McGinniss JH, Mason JS, Morris JB, Pitt W, Miller EM, Crowell MS. The Effect of Blood Flow Restriction Therapy on Shoulder Function Following Shoulder Stabilization Surgery: A Case Series. Int J Sports Phys Ther 2022; 17:1144-1155. [PMID: 36873568 PMCID: PMC9981204 DOI: 10.26603/001c.37865] [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: 03/09/2022] [Accepted: 06/10/2022] [Indexed: 11/12/2022] Open
Abstract
Background Traumatic shoulder instability is a common injury in athletes and military personnel. Surgical stabilization reduces recurrence, but athletes often return to sport before recovering upper extremity rotational strength and sport-specific abilities. Blood flow restriction (BFR) may stimulate muscle growth without the need for heavy resistance training post-surgically. Hypothesis/Purpose To observe changes in shoulder strength, self-reported function, upper extremity performance, and range of motion (ROM) in military cadets recovering from shoulder stabilization surgery who completed a standard rehabilitation program with six weeks of BFR training. Study Design Prospective case series. Methods Military cadets who underwent shoulder stabilization surgery completed six weeks of upper extremity BFR training, beginning post-op week six. Primary outcomes were shoulder isometric strength and patient-reported function assessed at 6-weeks, 12-weeks, and 6-months postoperatively. Secondary outcomes included shoulder ROM assessed at each timepoint and the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), the Upper Extremity Y-Balance Test (UQYBT), and the Unilateral Seated Shotput Test (USPT) assessed at the six-month follow-up. Results Twenty cadets performed an average 10.9 BFR training sessions over six weeks. Statistically significant and clinically meaningful increases in surgical extremity external rotation strength (p < 0.001; mean difference, .049; 95% CI: .021, .077), abduction strength (p < 0.001; mean difference, .079; 95% CI: .050, .108), and internal rotation strength (p < 0.001; mean difference, .060; CI: .028, .093) occurred from six to 12 weeks postoperatively. Statistically significant and clinically meaningful improvements were reported on the Single Assessment Numeric Evaluation (p < 0.001; mean difference, 17.7; CI: 9.4, 25.9) and Shoulder Pain and Disability Index (p < 0.001; mean difference, -31.1; CI: -44.2, -18.0) from six to 12 weeks postoperatively. Additionally, over 70 percent of participants met reference values on two to three performance tests at 6-months. Conclusion While the degree of improvement attributable to the addition of BFR is unknown, the clinically meaningful improvements in shoulder strength, self-reported function, and upper extremity performance warrant further exploration of BFR during upper extremity rehabilitation. Level of Evidence 4, Case Series.
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Affiliation(s)
- John H McGinniss
- Baylor University - Keller Army Community Hospital Division I Sports Physical Therapy Fellowship
| | - John S Mason
- Baylor University - Keller Army Community Hospital Division I Sports Physical Therapy Fellowship
| | - Jamie B Morris
- Baylor University - Keller Army Community Hospital Division I Sports Physical Therapy Fellowship
| | - Will Pitt
- Baylor University - Keller Army Community Hospital Division I Sports Physical Therapy Fellowship
| | - Erin M Miller
- Baylor University - Keller Army Community Hospital Division I Sports Physical Therapy Fellowship
| | - Michael S Crowell
- Baylor University - Keller Army Community Hospital Division I Sports Physical Therapy Fellowship
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Kemler BR, Rao S, Willier DP, Jack RA, Erickson BJ, Cohen SB, Ciccotti MG. Rehabilitation and Return to Sport Criteria Following Ulnar Collateral Ligament Reconstruction: A Systematic Review. Am J Sports Med 2022; 50:3112-3120. [PMID: 34494905 DOI: 10.1177/03635465211033994] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ulnar collateral ligament (UCL) reconstruction (UCLR) is a viable treatment option for patients with UCL insufficiency, especially in the overhead throwing athlete. Within the clinical literature, there is still no universally agreed upon optimal rehabilitation protocol and timing for return to sport (RTS) after UCLR. HYPOTHESIS There will be significant heterogeneity with respect to RTS criteria after UCLR. Most surgeons will utilize time-based criteria rather than functional or performance-based criteria for RTS after UCLR. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS All level 1 to 4 studies that evaluated UCLR with a minimum 1-year follow-up were eligible for inclusion. Studies lacking explicit RTS criteria, studies that treated UCL injury nonoperatively or by UCL repair, or studies reporting revision UCLR were excluded. Each study was analyzed for methodologic quality, RTS, timeline of RTS, and RTS rate. RESULTS Overall, 1346 studies were identified, 33 of which met the inclusion criteria. These included 3480 athletes across 21 different sports. All studies reported RTS rates either as overall rates or via the Conway-Jobe scale. Timelines for RTS ranged from 6.5 to 16 months. Early bracing with progressive range of motion (ROM) (93.9%), strengthening (84.8%), and participation in an interval throwing program (81.8%) were the most common parameters emphasized in these rehabilitation protocols. While all studies included at least 1 of 3 metrics for the RTS value assessment, most commonly postoperative rehabilitation (96.97%) and set timing after surgery (96.97%), no article completely defined RTS criteria after UCLR. CONCLUSION Overall, 93.9% of studies report utilizing bracing with progressive ROM, 84.8% reported strengthening, and 81.8% reported participation in an interval throwing program as rehabilitation parameters after UCLR. In addition, 96.97% reported timing after surgery as a criterion for RTS; however, there is a wide variability within the literature on the recommended time from surgery to return to activity. Future research should focus on developing a comprehensive checklist of functional and performance-based criteria for safe RTS after UCLR.
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Affiliation(s)
- Bryson R Kemler
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Somnath Rao
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Donald P Willier
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert A Jack
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | | | - Steven B Cohen
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
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15
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Tondelli E, Boerio C, Andreu M, Antinori S. Impact, incidence and prevalence of musculoskeletal injuries in senior amateur male rugby: epidemiological study. PHYSICIAN SPORTSMED 2022; 50:269-275. [PMID: 33906560 DOI: 10.1080/00913847.2021.1924045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Exposure to different types of injuries in rugby union is common. It is important to know about the injury epidemiology for medical teams care in order to optimize players´ performance and the treatment of common injuries, but there is limited specific information related to amateur rugby union. The purpose of this study is to determine the incidence, prevalence, injury burden, severity, nature of injuries sustained by senior amateur male rugby players from three clubs in Argentina during a given season. METHODS An observational, analytical, prospective, multicenter study was developed. Data collection was conducted from 15 March 2019 to 2 November 2019, during a complete season under the applicable standards of the Rugby Injury Consensus Group according to the Orchard Sports Injury and Illness Classification System.Incidence (injuries/1000 player-match-hours), prevalence (%), severity (time loss), injury burden (days lost/1000 player-match-hours), injured location and type of injury (%) were estimated. RESULTS 250 players and 180 injuries were assessed. Injury prevalence was 52.4%. Incidence rate per match and training was 30.9/1000 player-match-hours, and 0.77/1000 player-training-hours, respectively.The median injury severity score was 23 (IQR 12.7-52) days lost accounting for an injury burden of 97.3/1000 player-hours. Of the total, 113 (62.8%) injuries were contact injuries. The lower limbs were the most commonly affected (58.9%). Hamstring strain injury had the highest incidence and anterior cruciate ligament tear was the most severe injury. CONCLUSION The prevalence, incidence, and injury burden reported in this study are unprecedented and would add knowledge for the amateur rugby union community. Trainers, physicians, and physical therapists, should consider it to improve their clinical practice.
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Affiliation(s)
- Eduardo Tondelli
- Department of Physical Therapy and Sport Medicine, Rugby Club Los Matreros, Castelar, Buenos Aires, Argentina
| | - Carlos Boerio
- Department of Physical Therapy and Sport Medicine, Old Resian Club, Rosario, Argentina
| | - Mauro Andreu
- Biostatistician, Universidad Nacional De La Matanza (Unlam), San Justo, Argentina
| | - Santiago Antinori
- Department of Physical Therapy and Sport Medicine, Club Universitario De Córdoba, Córdoba, Argentina
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16
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Louati A, Bouche PA, Bauer T, Hardy A. Translation and validation of the shoulder instability-return to sport after injury (SIRSI) score in French. J Exp Orthop 2022; 9:41. [PMID: 35524076 PMCID: PMC9076763 DOI: 10.1186/s40634-022-00470-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- A Louati
- South Francilien Hospital, 40 avenue Serge Dassault, 91100, Corbeil-Essonnes, France. .,Georges Pompidou European Hospital, 20 Rue Leblanc, 75015, Paris, France.
| | - P A Bouche
- Lariboisière Hospital AP-HP, 2 rue Ambroise Paré, 75010, Paris, France
| | - T Bauer
- Ambroise-Paré Hospital AP-HP, 9 Avenue Charles De Gaulle, 92100, Boulogne-Billancourt, France
| | - A Hardy
- Sport Clinic, 36, Boulevard Saint-Marcel, 75005, Paris, France
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17
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Bravi M, Fossati C, Giombini A, Macaluso A, Lazzoli JK, Santacaterina F, Bressi F, Vorini F, Campi S, Papalia R, Pigozzi F. Criteria for Return-to-Play (RTP) after Rotator Cuff Surgery: A Systematic Review of Literature. J Clin Med 2022; 11:jcm11082244. [PMID: 35456339 PMCID: PMC9024603 DOI: 10.3390/jcm11082244] [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: 03/16/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
This systematic review of the literature aimed to highlight which criteria are described in the literature to define when a patient, after rotator cuff repair (RCR), is ready for return-to-play (RTP), which includes return to unrestricted activities, return to work, leisure, and sport activities. An online systematic search on the US National Library of Medicine (PubMed/MEDLINE), SCOPUS, Web of Science (WOS), and the Cochrane Database of Systematic Reviews, was performed with no data limit until December 2021. A total of 24 studies that reported at least one criterion after RCR were included. Nine criteria were identified and among these, the most reported criterion was the time from surgery, which was used by 78% of the studies; time from surgery was used as the only criterion by 54% of the studies, and in combination with other criteria, in 24% of the studies. Strength and ROM were the most reported criteria after time (25%). These results are in line with a previous systematic review that aimed to identify RTP criteria after surgical shoulder stabilization and with a recent scoping review that investigated RTP criteria among athletes after RCR and anterior shoulder stabilization. Compared to this latest scoping review, our study adds the methodological strength of being conducted according to the Prisma guidelines; furthermore, our study included both athletes and non-athletes to provide a comprehensive view of the criteria used after RCR; moreover, ten additional recent manuscripts were examined with respect to the scoping review.
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Affiliation(s)
- Marco Bravi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico, 00128 Rome, Italy; (M.B.); (F.S.); (F.B.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
- Correspondence:
| | - Arrigo Giombini
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
| | - José Kawazoe Lazzoli
- Biomedical Institute, Medical School, Fluminense Federal University, Niterói 24220-008, Brazil;
| | - Fabio Santacaterina
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico, 00128 Rome, Italy; (M.B.); (F.S.); (F.B.)
| | - Federica Bressi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico, 00128 Rome, Italy; (M.B.); (F.S.); (F.B.)
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, 00128 Rome, Italy; (F.V.); (S.C.); (R.P.)
| | - Stefano Campi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, 00128 Rome, Italy; (F.V.); (S.C.); (R.P.)
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, 00128 Rome, Italy; (F.V.); (S.C.); (R.P.)
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
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18
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Rossi LA, Pasqualini I, Tanoira I, Ranalletta M. Factors That Influence the Return to Sport After Arthroscopic Bankart Repair for Glenohumeral Instability. Open Access J Sports Med 2022; 13:35-40. [PMID: 35401017 PMCID: PMC8985826 DOI: 10.2147/oajsm.s340699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
Numerous studies have reported high rates of return to sports following arthroscopic Bankart repair (ABR) However, there is enormous controversy regarding the optimal management of these patients in the postoperative period. Controversy issues include rehabilitation, criteria for returning to sports, and the specific management of each athlete according to the sport they practice. Even though there are several rehabilitation protocols published in the literature, wide variability exists concerning the key elements of rehabilitation after an ABR. Regarding criteria for return to sports, there is a wide variation across the different published studies. The type of sports has been shown to affect an athlete's decision to return to sports. Nevertheless, most research is evaluated by classifications that cluster different sports into categories that may have other influences in return to sports when analyzed separately. Finally, in addition to physical readiness, the athlete's psychological state is crucial for returning to sports. However, the contribution of psychological readiness to an athlete's return to sports after shoulder instability surgery remains uncertain and unexplored.
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Affiliation(s)
- Luciano Andrés Rossi
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Ignacio Pasqualini
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
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19
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Matache BA, Hurley ET, Wong I, Itoi E, Strauss EJ, Delaney RA, Neyton L, Athwal GS, Pauzenberger L, Mullett H, Jazrawi LM. Anterior Shoulder Instability Part III-Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up-An International Consensus Statement. Arthroscopy 2022; 38:234-242.e6. [PMID: 34332051 DOI: 10.1016/j.arthro.2021.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to establish consensus statements via a modified Delphi process on revision surgery, rehabilitation and return to play, and clinical follow-up for anterior shoulder instability. METHODS A consensus process on the treatment using a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability. RESULTS The primary relative indications for revision surgery include symptomatic apprehension or recurrent instability, additional intra-articular pathologies, and symptomatic hardware failure. In revision cases, the differentiating factors that dictate treatment are the degree of glenohumeral bone loss and rotator cuff function/integrity. The minimum amount of time before allowing athletes to return to play is unknown, but other factors should be considered, including restoration of strength, range of motion and proprioception, and resolved pain and apprehension, as these are prognostic factors of reinjury. Additionally, psychological factors should be considered in the rehabilitation process. Patients should be clinically followed up for a minimum of 12 months or until a return to full, premorbid function/activities. Finally, the following factors should be included in anterior shoulder instability-specific, patient-reported outcome measures: function/limitations impact on activities of daily living, return to sport/activity, instability symptoms, confidence in shoulder, and satisfaction. CONCLUSION Overall, 92% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were indications and factors affecting decisions for revision surgery, as well as how prior surgeries impact procedure choice. Furthermore, there was unanimous consensus on the role of psychological factors in the return to play, considerations for allowing return to play, as well as prognostic factors. Finally, there was a lack of unanimous consensus on recommended timing and methods for clinical follow-up. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
| | - Eoghan T Hurley
- NYU Langone Health, New York, New York, USA; Sports Surgery Clinic, Dublin, Ireland.
| | - Ivan Wong
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eiji Itoi
- Tohoku University School of Medicine, Sendai, Japan
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20
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Hurley ET, Matache BA, Wong I, Itoi E, Strauss EJ, Delaney RA, Neyton L, Athwal GS, Pauzenberger L, Mullett H, Jazrawi LM. Anterior Shoulder Instability Part I-Diagnosis, Nonoperative Management, and Bankart Repair-An International Consensus Statement. Arthroscopy 2022; 38:214-223.e7. [PMID: 34332055 DOI: 10.1016/j.arthro.2021.07.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to establish consensus statements via a modified Delphi process on the diagnosis, nonoperative management, and Bankart repair for anterior shoulder instability. METHODS A consensus process on the treatment using a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability. RESULTS The independent factors identified in the 2 statements that reached unanimous agreement in diagnosis and nonoperative management were age, gender, mechanism of injury, number of instability events, whether reduction was required, occupation, sport/position/level played, collision sport, glenoid or humeral bone-loss, and hyperlaxity. Of the 3 total statements reaching unanimous agreement in Bankart repair, additional factors included overhead sport participation, prior shoulder surgery, patient expectations, and ability to comply with postoperative rehabilitation. Additionally, there was unanimous agreement that complications are rare following Bankart repair and that recurrence rates can be diminished by a well-defined rehabilitation protocol, inferior anchor placement (5-8 mm apart), multiple small-anchor fixation points, treatment of concomitant pathologies, careful capsulolabral debridement/reattachment, and appropriate indications/assessment of risk factors. CONCLUSION Overall, 77% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were the aspects of patient history that should be evaluated in those with acute instability, the prognostic factors for nonoperative management, and Bankart repair. Furthermore, there was unanimous consensus on the steps to minimize complications for Bankart repair, and the placement of anchors 5-8 mm apart. Finally, there was no consensus on the optimal position for shoulder immobilization. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Eoghan T Hurley
- NYU Langone Health, New York, New york, USA; Sports Surgery Clinic, Dublin, Ireland.
| | | | - Ivan Wong
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eiji Itoi
- Tohoku University School of Medicine, Sendai, Japan
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21
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Otley T, Myers H, Lau BC, Taylor DC. Return to Sport After Shoulder Stabilization Procedures: A Criteria-Based Testing Continuum to Guide Rehabilitation and Inform Return-to-Play Decision Making. Arthrosc Sports Med Rehabil 2022; 4:e237-e246. [PMID: 35141557 PMCID: PMC8811525 DOI: 10.1016/j.asmr.2021.09.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
The athlete with shoulder instability poses a unique challenge to the sports medicine team. Clinical studies support surgical intervention followed by a phased approach to rehabilitation. In the latter phases, it is important to tailor this program to the individual’s specific athletic needs, which requires ongoing qualitative assessment and objective measurement. Passing a return-to-sport testing battery has been shown to decrease the risk of recurrent instability. What is lacking in the literature is a consensus for how to best measure shoulder performance when the required athletic demands are widely varied by hand dominance, sport played, and playing position. Multiple upper-extremity tests have been described in the literature, but there is no consensus on which tests should be used to direct rehabilitation and to safely return the athlete to unrestricted athletic exposure. Using available evidence, we suggest a framework for return-to-play testing that integrates traditional rehabilitation phases with performance testing and graduated sports exposure. Level of Evidence Level V, expert opinion.
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Affiliation(s)
- Thomas Otley
- Duke Sports Sciences Institute, Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, U.S.A
| | - Heather Myers
- Duke Sports Sciences Institute, Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, U.S.A
| | - Brian C Lau
- Duke Sports Sciences Institute, Department of Orthopedic Surgery, Duke University Health System, Durham, North Carolina, U.S.A
| | - Dean C Taylor
- Duke Sports Sciences Institute, Department of Orthopedic Surgery, Duke University Health System, Durham, North Carolina, U.S.A
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22
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Kelley TD, Clegg S, Rodenhouse P, Hinz J, Busconi BD. Functional Rehabilitation and Return to Play After Arthroscopic Surgical Stabilization for Anterior Shoulder Instability. Sports Health 2021; 14:733-739. [PMID: 34918564 DOI: 10.1177/19417381211062852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND There exists limited objective functional return-to-play criteria after surgical stabilization for anterior shoulder instability in the competitive athlete. HYPOTHESIS The proposed functional rehabilitation program and psychological evaluation after arthroscopic Bankart repair will help athletes return to sport with a decreased redislocation rate on return. STUDY DESIGN Case series. LEVEL OF EVIDENCE Level 4. METHODS Participants were contact or overhead athletes at the high school or collegiate level. Each underwent arthroscopic Bankart repair after a single dislocation event, with less than 10% glenoid bone loss. Western Ontario Shoulder Instability Index (WOSI) scores, Single Assessment Numeric Evaluation (SANE) scores, and American Shoulder and Elbow Surgeons (ASES) scores were evaluated pre- and postoperatively. Athletes were only allowed to return to competition after completing the proposed functional and psychological rehabilitation protocol. RESULTS A total of 62 participants were enrolled (52 male, 10 female; average age, 18.7 years (range 16-24 years); mean Instability Severity Index Score, 5.63 ± 0.55). All returned to sport for 1 full season and completed a minimum of 2 years of follow-up. The average time to pass functional testing was 6.2 ± 0.7 months, psychological testing was 5.2 ± 0.5 months, and return to sport was 6.5 ± 0.7 months. SANE scores improved from 44.3 to 90.0, ASES from 45.5 to 89.3, and WOSI from 1578.0 to 178.9 (all P < 0.001). Redislocation rate was 6.5% (4 of 62). CONCLUSION The proposed functional rehabilitation and psychological assessment protocol is safe and effective in returning athletes to sport after arthroscopic surgical intervention for anterior shoulder instability. This demonstrated a low redislocation rate after 2-year follow-up. CLINICAL RELEVANCE Most return-to-play protocols after arthroscopic Bankart repair are centered on recovery time alone, with limited focus on functional rehabilitation, psychological assessment, and return-to-play testing parameters. To our knowledge, this is the first study to propose a dedicated rehabilitation program incorporating functional testing, psychological readiness, and return-to-play criteria for competitive athletes recovering from arthroscopic shoulder stabilization.
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Affiliation(s)
- Timothy D Kelley
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Stephanie Clegg
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Paul Rodenhouse
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Jon Hinz
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Brian D Busconi
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, Massachusetts
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23
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Griffith R, Bolia IK, Fretes N, Murray IR, Meyer J, Weber AE, Gamradt SC, Petrigliano FA. Return-to-Sport Criteria After Upper Extremity Surgery in Athletes-A Scoping Review, Part 2: Ulnar Collateral Ligament of the Elbow Procedures. Orthop J Sports Med 2021; 9:23259671211021825. [PMID: 34395685 PMCID: PMC8358522 DOI: 10.1177/23259671211021825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background: There is a lack of consensus to guide patient return to sport (RTS) after elbow ulnar collateral ligament surgery (eUCLS). Purpose: To describe the reported RTS criteria after eUCLS in the athletic population. Study Design: Scoping review; Level of evidence, 4. Methods: This scoping review was performed by adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Scoping Review) guidelines. We searched 5 electronic databases (MEDLINE, Scopus, SPORTDiscus, Embase, Google Scholar Advanced) and the gray literature for English-language studies that reported at least 1 RTS criterion in athletes after eUCLS. Data were extracted and summarized as frequencies or arithmetic mean and standard deviation. Results: Included were 14 studies and 1335 athletes with a mean age of 21.4 ± 1.1 years. Time from surgery (range, 6-16 months) was the most common RTS criterion used, and it was reported by all 14 of the included articles. RTS criteria reported less often were pain (3/14; 21%), successful completion of a throwing program (3/14; 21%), muscle strength of the forearm muscles (1/14; 7%), and “normal” range of motion and muscle strength of the elbow and shoulder joints on the operated upper extremity (1/14; 7%). All studies used 1 to 5 of the above RTS criteria. Conclusion: Only 14 studies reported 1 or more RTS criteria after eUCLS in athletes, and time was the most common RTS criterion used. Our results highlight the need for a coordinated effort among surgeons, physical therapists, and athletic trainers in order to establish evidence-based RTS criteria after eUCLS in athletes so athletes can safely to sport and prolong their athletic careers.
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Affiliation(s)
- Rebecca Griffith
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Nickolas Fretes
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Iain R Murray
- Department of Orthopaedic Sports Medicine, Stanford University, Redwood City, California, USA
| | - John Meyer
- Meyer Institute of Sport, Los Angeles, California, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Seth C Gamradt
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
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Griffith R, Fretes N, Bolia IK, Murray IR, Meyer J, Weber AE, Gamradt SC, Petrigliano FA. Return-to-Sport Criteria After Upper Extremity Surgery in Athletes-A Scoping Review, Part 1: Rotator Cuff and Shoulder Stabilization Procedures. Orthop J Sports Med 2021; 9:23259671211021827. [PMID: 34395687 PMCID: PMC8358521 DOI: 10.1177/23259671211021827] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Standardized criteria are lacking to guide patient return to sport (RTS) after rotator cuff surgery (RCS) or shoulder stabilization surgery (SSS). Purpose: To describe RTS criteria used after RCS and SSS in athletic populations. Study Design: Scoping review; Level of evidence, 4. Methods: This scoping review was based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Scoping Review) guidelines. A total of 5 electronic databases (MEDLINE, Scopus, SPORTDiscus, Embase, Google Scholar Advanced search) and the gray literature were searched for English-language studies that reported at least 1 RTS criterion in athletes after shoulder surgery. Studies were assigned to the RCS or SSS subgroup based on the primary procedure performed. Data were extracted and summarized as frequencies or arithmetic mean and standard deviation. Results: Included were 52 studies and 2706 athletes (2206 male, 500 female, with a mean age of 28.8 ± 1.8 years). The RCS group consisted of 14 studies and the SSS group consisted of 38 studies. Time from surgery was the most common RTS criterion reported overall (37/52 studies; 71%) as well as within the RCS (93%) and SSS (63%) subgroups. Muscle strength (25/52 studies; 48%) and range of motion (23/52; 44%) were used by almost half of the included articles. RTS criteria reported less often were absence of pain, successful completion of sport-specific or position-specific test, proprioception, radiographic evaluation, patient-surgeon agreement, minimum time required to participate in pain-free throwing, and satisfactory scapulothoracic mechanics. All studies used 1 to 3 of the above RTS criteria; however, the definition of each criterion differed among the included articles. Conclusion: Time from surgery was the most commonly reported RTS criterion after RCS or SSS in athletes, whereas muscle strength and range of motion were used by almost half of the articles. There was high heterogeneity in the definition of each RTS criterion used among the included studies, which also used different combinations of 1 to 3 RTS criteria. These results suggest the need to better define quantitative and qualitative RTS criteria in athletes undergoing rotator cuff and shoulder stabilization procedures in order to safely return athletes to sport.
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Affiliation(s)
- Rebecca Griffith
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Nickolas Fretes
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Iain R Murray
- Department of Orthopaedic Sports Medicine, Stanford University, Redwood City, California, USA
| | - John Meyer
- Meyer Institute of Sport, Los Angeles, California, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Seth C Gamradt
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
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Sayaca C, Unal M, Calik M, Eyuboglu FE, Kaya D, Ozenci AM. Scapular Dyskinesis, Shoulder Joint Position Sense, and Functional Level After Arthroscopic Bankart Repair. Orthop J Sports Med 2021; 9:2325967120985207. [PMID: 34377720 PMCID: PMC8335837 DOI: 10.1177/2325967120985207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/04/2020] [Indexed: 11/27/2022] Open
Abstract
Background: Scapular kinesia is an important component of glenohumeral rhythm and shoulder stability. No studies have evaluated scapular dyskinesis and its relationship to shoulder proprioception in patients who have undergone arthroscopic Bankart repair (ABR). Purpose: To investigate scapular dyskinesis, proprioception, and functional level after ABR. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 13 male patients who underwent ABR (ABR group; mean age, 30 years; range, 24-36 years) and 13 sex- and age-matched healthy individuals (control group). The age, height, weight, and dominant side of all participants were collected. Scapular dyskinesis was evaluated using the lateral scapular slide test and the scapular dyskinesis test; proprioception was measured by the active angle reproduction test using a smartphone goniometer application, and functional level was assessed using the upper-quarter Y-balance test for dynamic stability as well as the Rowe score and Walch-Duplay score for quality of life and return to activities of daily living. Results: The presence of static scapular dyskinesis in the neutral position, at 45° of abduction, and at 90° of abduction as well as the presence of dynamic scapular dyskinesis was higher in the ABR group compared with the control group (P ≤ .04 for all). Shoulder joint position sense (absolute error) at 40° and 100° of shoulder elevation and shoulder functional level according to the Rowe score were worse in the ABR patients compared with the healthy controls (P ≤ .02 for all). Dynamic scapular dyskinesis was negatively related to shoulder joint position sense at 40° of shoulder elevation (r = –0.64; P = .01). Static scapular movement as measured on the lateral scapular slide test was moderately related to the Rowe score (r = 0.58; P = .03). Conclusion: Scapular kinematics and proprioception should be evaluated after ABR. Treatment approaches to improve scapular control and proprioceptive sense should be included in the rehabilitation program for patients after ABR.
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Affiliation(s)
- Cetin Sayaca
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bursa Uludag University, Bursa, Turkey
| | | | - Mahmut Calik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Uskudar University, Istanbul, Turkey
| | - Filiz Erdem Eyuboglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Uskudar University, Istanbul, Turkey
| | - Defne Kaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bursa Uludag University, Bursa, Turkey
| | - A Merter Ozenci
- Department of Orthopaedics and Traumatology, MedicalPark Hospitals, Antalya, Turkey
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Pavlik A, Tátrai M, Tátrai A, Tállay A. Outcomes After Arthroscopic Anterior Shoulder Stabilization in Professional Handball Players. Orthop J Sports Med 2021; 9:23259671211011614. [PMID: 34368376 PMCID: PMC8299888 DOI: 10.1177/23259671211011614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/12/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Although numerous studies have reported on the redislocation rate and functional results of arthroscopic treatment for anterior shoulder instability in athletes, they have not disclosed outcomes in the high-risk group of elite handball players. Purpose: To investigate the postoperative outcomes of arthroscopic treatment for anterior shoulder instability as well as the return-to-sport (RTS) rate in professional handball players. Study Design: Case series; Level of evidence, 4. Methods: Involved in this study were 44 competitive handball players (47 shoulders) who underwent arthroscopic anterior capsulolabral reconstruction between 2010 and 2018 and had a minimum follow-up of 24 months. After surgery, patients completed a questionnaire that collected Rowe and American Shoulder and Elbow Surgeons (ASES) scores and RTS data, and we compared these results with their preoperative scores. We also compared results according to the following subgroups: true dislocations versus recurrent subluxations, younger (<20 years) versus older (≥20 years) age, male versus female sex, and shorter versus longer duration of instability. Statistical analysis included the paired-samples t test and nonparametric Fisher exact test. Results: The mean follow-up period was 52.2 ± 21.4 months. There were 4 shoulders (9%) with recurrent instability. There were significant preoperative to postoperative improvements in the mean Rowe score (from 45.2 to 91.8) and mean ASES score (from 70.6 to 95.7) (P < .001 for both). Overall, the RTS rate was 83%, and 64% (30/47 shoulders) were able to return to their preinjury level. The RTS rate was significantly lower in the younger players than in the older players (46% vs 86%, respectively; P = .005). Conclusion: The study results indicated that handball players with anterior shoulder instability can be treated using arthroscopic labral reconstruction successfully and 83% of the athletes were able to RTS activity. The handball players aged ≥20 years returned to their preinjury level of sport at a higher rate than did those aged <20 years.
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Affiliation(s)
- Attila Pavlik
- Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary.,Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary.,Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary
| | - Miklós Tátrai
- Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary.,Kastélypark Clinic, Tata, Hungary
| | | | - András Tállay
- Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary.,Faculty of Sport Medicine, Semmelweis University, Budapest, Hungary.,Kastélypark Clinic, Tata, Hungary
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Rossi LA, Frank RM, Wilke D, Provencher CMT, Millet PJ, Romeo A, Walch G, Lo I, Yamamoto N, Bokor D, Di Giacomo G, Tokish J, Lech O, Itoi E, Garrigues G, Scheibel M, Boileau P, Calvo E, Arce G, Toro F, Sugaya H, Ranalletta M, Parada S, Savoie F, Verma NN, Chahla J. Evaluation and Management of Glenohumeral Instability With Associated Bone Loss: An Expert Consensus Statement Using the Modified Delphi Technique. Arthroscopy 2021; 37:1719-1728. [PMID: 33453347 DOI: 10.1016/j.arthro.2020.12.237] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To establish an international expert consensus, using the modified Delphi technique, on the evaluation and management of glenohumeral instability with associated bone loss. METHODS A working group of 6 individuals generated a list of statements related to history and physical examination, imaging and specialized diagnostic tests, bone loss quantification and classification, treatment outcomes and complications, and rehabilitation for the management of glenohumeral instability associated with bone loss to form the basis of an initial survey for rating by a group of experts. The expert group (composed of 22 high-volume glenohumeral instability experts) was surveyed on 3 occasions to establish a consensus on the statements. Items with over 70% agreement and less than 10% disagreement achieved consensus. RESULTS After a total of 3 rounds, 31 statements achieved consensus. Eighty-six percent of the experts agreed that a history of multiple dislocations and failed soft-tissue surgery should raise suspicion about the possibility of an associated bone deficit. Ninety-five percent of the experts agreed that 3-dimensional (3D) computed tomography (CT) is the most accurate diagnostic method to evaluate and quantify bone loss. Eighty-six percent of the experts agreed that any of the available methods to measure glenoid bone deficiency is adequate; however, 91% of the experts thought that an en face view of the glenoid using 3D CT provides the most accurate method. Ninety-five percent of the experts agreed that Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Ninety percent of the experts agreed that in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed and any of the available options is valid. There was no consensus among experts on how Hill-Sachs injuries should be managed or on how postoperative rehabilitation should be carried out. CONCLUSIONS The essential statements on which the experts reached consensus included the following: A history of multiple dislocations and failed soft-tissue surgery should make surgeons consider the possibility of an associated bone deficit. Three-dimensional CT is the most accurate diagnostic method to evaluate and quantify bone loss. Although any of the available methods to measure glenoid bone deficiency is adequate, an en face view of the glenoid using 3D CT provides the most accurate method. Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Finally, in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed. LEVEL OF EVIDENCE Level V, consensus statement.
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Affiliation(s)
| | - Rachel M Frank
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | | | | | | | | | - Ian Lo
- The Steadman Clinic, Vail, Colorado, U.S.A
| | | | | | | | | | | | - Eiji Itoi
- The Steadman Clinic, Vail, Colorado, U.S.A
| | | | | | | | | | | | | | | | | | | | | | | | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, U.S.A
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Return to play criteria among shoulder surgeons following shoulder stabilization. J Shoulder Elbow Surg 2021; 30:e317-e321. [PMID: 33618019 DOI: 10.1016/j.jse.2021.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to survey the members of North American and European shoulder surgery and sports medicine societies to evaluate their criteria for deciding when an athlete can safely return to play (RTP) following shoulder stabilization surgery. METHODS A survey was sent to the members of the American Shoulder and Elbow Surgeons (ASES), American Orthopaedic Society for Sports Medicine (AOSSM), European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), and European Society for Surgery of the Shoulder and the Elbow (SECEC). Surgeons were asked which criteria they used to determine when an athlete can return to play following the arthroscopic Bankart repair and Latarjet procedures, with additional questions on how time from surgery and participation in collision sports affect return. RESULTS Overall, 317 surgeons responded to the survey. Following arthroscopic Bankart repair, the most common criteria used were time (98.7%), strength (74.8%), and range of motion (70%). The most commonly reported time point was 4 months (43.8%), and the majority used an additional time period, most commonly 2 months (38.2%), before allowing a collision athlete to return to play (75.4%). Interestingly, the addition of a remplissage procedure did not affect decision making regarding RTP in most cases (92.1%). Following the Latarjet procedure, the most common criteria used were time (98.4%), strength (67.5%), and range of motion (65.9%). Less than half reported using imaging to assess for radiographic union before allowing patients to return to play (47%), and the most common modality was plain radiography (80%). The most common time point was 4 months (33.1%), and the majority reported waiting an additional period of time, most commonly by 2 months (25.9%), before allowing a collision athlete to return to play (59.6%). CONCLUSION Despite the absence of evidence-based guidelines on when athletes can safely return to play following shoulder stabilization surgery, there exists minimal variability in recommendations between North American and European shoulder surgeons. Further research is required to better define criteria for RTP after the arthroscopic Bankart repair and Latarjet procedures.
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Fanning E, Daniels K, Cools A, Miles JJ, Falvey É. Biomechanical upper-extremity performance tests and isokinetic shoulder strength in collision and contact athletes. J Sports Sci 2021; 39:1873-1881. [PMID: 33874850 DOI: 10.1080/02640414.2021.1904694] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was threefold (1) to assess the reliability of three upper-extremity performance tests: a countermovement push up, press jump and drop box land, performed on a set of dual-force plates (2) to examine whether there was an association between isokinetic dynamometry and the performance tests in a non-injured cohort of collision/contact athletes and (3) to establish a normal descriptive profile of the vertical ground reaction forces from the performance tests, in a cohort of contact/collision athletes. The study was split into two sub-sections; the inter-day reliability of three upper-extremity performance tests (n = 21) and a descriptive, correlation study investigating the relationship between isokinetic dynamometry and performance tests metrics (n = 39). We used intraclass correlation coefficients (absolute agreement, 2-way mixed-effects model) with 95% confidence intervals to quantify inter-day reliability of all variables. We used Pearson correlation coefficients to investigate associations between isokinetic strength and vertical ground reaction force asymmetry variables. Inter-day reliability was moderate-to-excellent for the upper-extremity performance tests (ICC 0.67-0.97). There was no statistically significant correlation between external and internal rotational peak torque and the variables of CPMU, PJ and BDL (r range = .02-.24).These upper-extremity tests are reliable for use with male contact/collision athletes.
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Affiliation(s)
- Edel Fanning
- Sports Medicine, Sports Surgery Clinic, Dublin, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Katherine Daniels
- Sports Medicine, Sports Surgery Clinic, Dublin, Ireland.,Queen's School of Engineering, University of Bristol, University Walk, Bristol, UK
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Gent, Belgium
| | - Josh J Miles
- Department for Health, University of Bath, Bath, UK
| | - Éanna Falvey
- Sports Medicine, Sports Surgery Clinic, Dublin, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
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Juré D, Blache Y, Degot M, Vigne G, Nové-Josserand L, Godenèche A, Collotte P, Franger G, Borel F, Rogowski I, Neyton L. The S-STARTS Test: Validation of a Composite Test for the Assessment of Readiness to Return to Sport After Shoulder Stabilization Surgery. Sports Health 2021; 14:254-261. [PMID: 33834924 DOI: 10.1177/19417381211004107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The time elapsed since surgery is the primary criterion for allowing athletes to return to sport after shoulder stabilization surgery using the Latarjet procedure. The objective assessment of shoulder functional status through the return-to-sport continuum demands a scoring instrument that includes psychological and physical dimensions. This study aimed to statistically validate the Shoulder-SanTy Athletic Return To Sport (S-STARTS) score in patients who have undergone primary shoulder stabilization surgery. HYPOTHESIS The S-STARTS score fulfils the criteria for statistical validation for assessing return-to-sport readiness after shoulder stabilization surgery. STUDY DESIGN Diagnostic study. LEVEL OF EVIDENCE Level 4. METHODS Fifty patients and 50 controls completed the Shoulder Instability-Return to Sport after Injury questionnaire and performed 4 physical performance tests, from which 8 outcome measures were extracted to provide a composite score, named S-STARTS, according to a scoring procedure. The statistical validation of the S-STARTS score was based on construct validity, discriminant validity, sensitivity to change, internal consistency, reliability, agreement, and feasibility. RESULTS The 8 components of the S-STARTS score provided additional information (0.01 ≤ |r| ≤ 0.59). The S-STARTS score exhibited good reliability (intraclass coefficient of correlation [3,k] = 0.74), no ceiling or floor effects, and high discrimination and sensitivity to change. The S-STARTS score was significantly lower in patients than in controls (13.5 ± 3.8 points vs 16.1 ± 2.7 points, respectively; P < 0.001). A significant increase was reported between 4.5 and 6.5 months postoperatively (12.8 ± 2.3 points vs 17.2 ± 2.4 points, respectively; P < 0.001). CONCLUSIONS The S-STARTS score meets statistical validation criteria for the assessment of shoulder functional status after shoulder stabilization surgery using the Latarjet procedure. CLINICAL RELEVANCE Using an S-STARTS score-based assessment to monitor an athlete's progression through the return-to-sport continuum may help clinicians and strength and conditioning coaches in return-to-sport decision-making.
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McIsaac W, Lalani A, Silveira A, Chepeha J, Luciak-Corea C, Beaupre L. Rehabilitation after arthroscopic Bankart repair: a systematic scoping review identifying important evidence gaps. Physiotherapy 2021; 114:68-76. [PMID: 34598773 DOI: 10.1016/j.physio.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evidence to develop best rehabilitation practices after Arthroscopic Bankart Repair (ABR) is lacking, leading to heterogeneity in rehabilitation approaches. OBJECTIVES This systematic scoping review investigated current evidence for rehabilitation and associated outcomes following ABR, including rehabilitation parameters, evaluative approaches (outcomes/outcome measures, follow-up timing/duration). DATA SOURCES A systematic search was performed of CINAHL, MEDLINE, and Embase databases in May 2019. STUDY SELECTION Prospective studies detailing rehabilitation protocols following ABR reporting at least one postoperative assessment within 1 year of surgery (to measure impact of rehabilitation) were included. DATA EXTRACTION AND SYNTHESIS Two blinded reviewers independently selected studies using standardized criteria and extracted study characteristics and outcomes of interest. Quality of evidence was assessed using Joanna Brigg's quality assessment tool. A narrative analysis was conducted and evidence gaps were identified. RESULTS Nine studies evaluating 11 rehabilitation protocols with a total of 384 participants were included. Considerable variability was seen in rehabilitation protocols and evaluation parameters. Return to sports/activity was frequently measured, but not well-defined. Strengthening was an important component of rehabilitation protocols, but rarely reported as an outcome. Follow-up was variable, with 4 studies ending follow-up before 24-months postoperatively. Overall, patient outcomes improved postoperatively. CONCLUSIONS There is a paucity of evidence investigating the impact of rehabilitation approaches following ABR. Although patient outcomes improve after ABR, selected outcomes/measures are highly variable with limited evidence on those important to measure rehabilitation success, particularly strength and return to activity. Identified evidence gaps should be addressed in future research.
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Affiliation(s)
- Willem McIsaac
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Canada
| | - Amaan Lalani
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton Alberta, Canada T6G 2B4
| | - Anelise Silveira
- Department of Surgery, Alberta Health Services, 6-110 Clinical Sciences Building, 8224-112St, Edmonton, AB, Canada T6G 2G3; Shoulder and Upper Extremity Research Group of Edmonton, 6-110 Clinical Sciences Building, 8224-112St, Edmonton, AB, Canada T6G 2G3
| | - Judy Chepeha
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton Alberta, Canada T6G 2B4; Shoulder and Upper Extremity Research Group of Edmonton, 6-110 Clinical Sciences Building, 8224-112St, Edmonton, AB, Canada T6G 2G3
| | - Charlene Luciak-Corea
- Shoulder and Upper Extremity Research Group of Edmonton, 6-110 Clinical Sciences Building, 8224-112St, Edmonton, AB, Canada T6G 2G3
| | - Lauren Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton Alberta, Canada T6G 2B4; Shoulder and Upper Extremity Research Group of Edmonton, 6-110 Clinical Sciences Building, 8224-112St, Edmonton, AB, Canada T6G 2G3.
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Bohu Y, Abadie P, van Rooij F, Nover L, Berhouet J, Hardy A. Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores. Knee Surg Sports Traumatol Arthrosc 2021; 29:2606-2615. [PMID: 33743029 PMCID: PMC8298242 DOI: 10.1007/s00167-021-06475-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Systematic reviews report return to play (RTP) within 5.8 months (range, 3-8) following the Latarjet procedure, but the factors that influence RTP remain unknown. The present study aimed to report the rate and time of return to play (RTP) during the first 8 months following the Latarjet procedure, and to determine the influence of sport type or patient characteristics. METHODS The authors retrospectively collected the records of patients that underwent Latarjet procedures for anterior shoulder instability between 2015 and 2017. Patients were excluded if they had any concomitant rotator cuff tendon lesions, or previous ipsilateral shoulder surgery. The authors retrieved patient demographics, time from injury to surgery, type of sport practiced (overhead/non-overhead, contact/non-contact), as well as pre- and postoperative Western Ontario Shoulder Instability index (WOSI), Shoulder Instability-Return to Sport After Injury index (SIRSI), and Rowe score. RESULTS A total of 217 patients (217 shoulders) were eligible for inclusion, comprising 184 males and 33 females, aged 26.8 ± 7.3 years at index surgery. The main sport practiced prior to surgery involved overhead (n = 173, 80%) and/or contact (n = 152, 70%) activities. By 8 month follow-up, 158 patients (73%) resumed their main sport, at a mean of 5.1 ± 1.5 months. Multivariable analysis revealed that RTP was more likely in patients with higher preoperative Rowe score (OR, 1.02; p = 0.024) and SIRSI score (OR, 1.02; p = 0.008). CONCLUSIONS By 8 months following the Latarjet procedure, 73% of patients had resumed their main sport. The likelihood of RTP was significantly associated with preoperative Rowe and SIRSI scores, but not with sport type. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yoann Bohu
- Clinique du Sport Paris V, Ramsay Santé, Paris, France.
| | - Pierre Abadie
- Clinique du Sport de Bordeaux-Merignac, Mérignac, France
| | | | - Luca Nover
- ReSurg SA, 22 Rue Saint Jean, 1260 Nyon, Switzerland
| | | | | | - Alexandre Hardy
- Clinique du Sport Paris V, Ramsay Santé, Paris, France ,Ambroise Paré Hospital, Boulogne-Billancourt, France
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The majority of patients return to athletic activity following biceps tenodesis. Knee Surg Sports Traumatol Arthrosc 2021; 29:216-222. [PMID: 32185452 DOI: 10.1007/s00167-020-05930-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Biceps tenodesis is widely used as a primary treatment for long head of the biceps brachii pathology and superior labral anterior and posterior (SLAP) lesions. However, rates and timing of full return to sports (RTSs)/duty have not been systematically analysed. This systematic review examines the literature to ascertain the rate and timing of return to athletic activity, and the availability of specific criteria for safe return to atheletic activity following the biceps tenodesis. METHODS Based on PRISMA guidelines, this systematic review utilised the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to athletic activity following biceps tenodesis. Statistical analysis was performed using SPSS. RESULTS This review identified 17 studies including 374 cases meeting the inclusion criteria. The majority of patients were men 260 (69.7%), with an median age of 42.2 years (range 16-88) and a mean follow-up of 37.4 months. The overall rate of RTS was 217/269 (80.7%), with 43/59 (72.9%) returning to the same level. In overhead athletes, the overall rate of return to play was 39/49 (79.6%). Among military personnel, the overall rate of return to duty was 61/74 (82.4%). The average time to RTS was 5.4 (range 3-11) months. 10 (58.8%) Studies reported a recommended time window within which patients were allowed to return to full activity. Specific criteria for return to play were not reported in any of the identified studies. CONCLUSION While overall rate of return to athletic activity was reportedly high following biceps tenodesis, one in four patients were not able to resume athletic activity at the same level. At present, there is no objective assessment of when patients can return to full activity reported in the literature. LEVEL OF EVIDENCE IV.
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Fried JW, Hurley ET, Duenes ML, Manjunath AK, Virk M, Gonzalez-Lomas G, Campbell KA. Return to Play After Arthroscopic Stabilization for Posterior Shoulder Instability-A Systematic Review. Arthrosc Sports Med Rehabil 2020; 3:e249-e256. [PMID: 33615272 PMCID: PMC7879176 DOI: 10.1016/j.asmr.2020.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/19/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To ascertain the rate and timing of return to play (RTP) and the availability of specific criteria for safe RTP after arthroscopic posterior shoulder stabilization. Methods Medline, EMBASE, and the Cochrane Library were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to find studies on arthroscopic posterior shoulder stabilization. Studies were included if they reported RTP data or rehabilitation protocols and excluded if concomitant procedures influenced the rehabilitation protocol. Rate and timing of RTP, along with rehabilitation protocols, were assessed. Results This review found 25 studies, including 895 cases, meeting the study’s inclusion criteria. The majority of patients were male (82.7%), with an age range of 14 to 66 years and a follow-up range of 4 to 148.8 months. The overall RTP rate ranged from 62.7% to 100.0%, and 50.0% to 100.0% returned to the same level of play. Among collision athletes, the overall rate of RTP was 80.0% to 100.0%, with 69.2%-100.0% returning to the same level of play. In overhead athletes, the overall rate of RTP was 85.2% to 100.0%, with 55.6% to 100.0% returning to the same level of play. Four studies (128 patients) specifically addressed the timing of RTP, and the range to RTP was 4.3 to 8.6 months. Specific RTP criteria were reported in a majority of studies (60%), with the most reported item being restoration of strength (44%). Conclusion There is a high rate of return to sport after arthroscopic posterior shoulder stabilization, ranging from 4.3 to 8.6 months after surgery. Return to preinjury level is higher for collision athletes compared with overhead athletes. However, there is inadequate reporting of RTP criteria in the current literature, with no clear timeline for when it is safe to return to sport. Level of Evidence IV, systematic review of level II to IV studies
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Affiliation(s)
- Jordan W. Fried
- Address correspondence to Jordan W. Fried, Division of Sports Medicine, NYU Langone Orthopedic Center, 333 East 38th Street, New York, NY 10016, U.S.A.
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Fanning E, Maher N, Cools A, Falvey EC. Outcome Measures After Shoulder Stabilization in the Athletic Population: A Systematic Review of Clinical and Patient-Reported Metrics. Orthop J Sports Med 2020; 8:2325967120950040. [PMID: 32984424 PMCID: PMC7498977 DOI: 10.1177/2325967120950040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/07/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Athletic endeavor can require the “athletic shoulder” to tolerate significant
load through supraphysiological range and often under considerable
repetition. Outcome measures are valuable when determining an athlete’s safe
return to sport. Few data are available to guide a clinician’s choice from
the variety of measures available. Purpose: To describe the use of quantifiable objective outcome measures and
patient-reported outcome tools after glenohumeral joint stabilization,
specifically in an athletic population. The secondary aim of our study was
to assess whether the method of measurement used was clearly described and
standardized to aid clinical interpretation. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of MEDLINE, Scopus, SPORTDiscus, and Web of Science
databases was performed in December 2018 based on the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. After
the application of selection criteria, a full review of identified papers,
and screening of reference lists, a total of 62 studies were included in the
review. All studies were independently appraised for quality, predefined
data fields were populated and cross-checked for accuracy, and results were
then summarized from these data fields. Results: Of the 62 included studies, 94% used a quantifiable objective clinical
outcome. A majority (85%) of the studies measured range of motion, 21%
recorded muscle strength, 5% measured electromyographic activity, 5%
examined shoulder kinematics, and 3% assessed joint proprioception after
surgery. However, only 18% of the studies clearly described a standardized
method of measuring the outcome. Nearly all (95%) of the studies used at
least 1 patient-reported outcome measure. The Rowe score was most commonly
used (35%). Conclusion: We must standardize and clearly describe the use of quantifiable objective
outcome measures to aid clinical interpretation. A concerted effort should
also be made to standardize the use of patient-reported outcome tools after
shoulder stabilization in the athletic population.
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Affiliation(s)
- Edel Fanning
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
| | - Natasha Maher
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Gent, Belgium
| | - Eanna C Falvey
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
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Okutan AE, Ayas MS, Gül O. Editorial Commentary: What is the Difference That Makes the Differences? The Practical Rationality of the All-Suture Anchor. Arthroscopy 2020; 36:2103-2105. [PMID: 32747058 DOI: 10.1016/j.arthro.2020.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
Suture anchor technologies are constantly being innovated in the quest for improved stability, biological integration and clinical outcomes. However, the decision about the choice of suture-anchor materials remain elusive. There are some factors, including reliability, effectiveness, simplicity, familiarity, and cost, that affect a surgeon's preference. The relative weights placed on different factors by different surgeons play decisive roles in individual choice. But decisions and choices are not arbitrary or merely subjective. Alternative options can be warranted or contested by rational argumentation. At the end, there may be losses and gains in the change of 1 suture anchor for another, but science does progress.
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Rogowski I, Degot M, Juré D, Hager JP, Neyton L, Blache Y. Shoulder functional status in rugby union players with and without history of shoulder problems. Phys Ther Sport 2020; 45:71-75. [PMID: 32653845 DOI: 10.1016/j.ptsp.2020.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the effects of (1) rugby union practice, (2) history of injury managed nonoperatively, and (3) history of injury managed operatively on shoulder functional status in male rugby union players. DESIGN Cross sectional study. SETTING Clinical. PARTICIPANTS 86 male athletes were assigned into four groups: multisport athletes, rugby union players without shoulder problems, with history of shoulder injury managed nonoperatively and with history of shoulder injury managed operatively. MAIN OUTCOME MEASURES SI-RSI questionnaire, maximal isometric glenohumeral internal and external rotator strength, unilateral seated shot put test, upper quarter Y balance test. RESULTS Healthy players presented higher internal (p = 0.03) and external (p = 0.04) rotator strength than multisport athletes. History of shoulder injury managed nonoperatively did not impair physical abilities but limited player's psychological readiness (p < 0.001). After 4.5-months, shoulder stabilization surgery impaired maximal muscle strength and upper quarter body stability and mobility (p < 0.001 for all). CONCLUSIONS The shoulder functional status in rugby union player presented increased glenohumeral rotator strength when compared to non-collision sport athletes. In rugby union players, psychological concerns remained in the long-term after a shoulder injury managed nonoperatively, and psychological and physical readiness seemed not be reached at 4.5 months postoperatively to respond to rugby union practice demand.
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Affiliation(s)
- Isabelle Rogowski
- Université de Lyon, Université Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité - EA 7424, UFRSTAPS, 27-29 boulevard du 11 novembre 1918, 69622, Villeurbanne Cedex, France.
| | - Matthieu Degot
- Université de Lyon, Université Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité - EA 7424, UFRSTAPS, 27-29 boulevard du 11 novembre 1918, 69622, Villeurbanne Cedex, France
| | - Dimitri Juré
- Université de Lyon, Université Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité - EA 7424, UFRSTAPS, 27-29 boulevard du 11 novembre 1918, 69622, Villeurbanne Cedex, France; Athletic France, 4 rue Jean Sarrazin, 69008, Lyon, France
| | - Jean-Philippe Hager
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, 24 avenue Paul Santy, 69008, Lyon, France
| | - Lionel Neyton
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, 24 avenue Paul Santy, 69008, Lyon, France; Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
| | - Yoann Blache
- Université de Lyon, Université Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité - EA 7424, UFRSTAPS, 27-29 boulevard du 11 novembre 1918, 69622, Villeurbanne Cedex, France
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Frantz TL, Everhart JS, Cvetanovich GL, Neviaser A, Jones GL, Hettrich CM, Wolf BR, Baumgarten KM, Bollier MJ, Bravman JT, Kuhn JE, Ma CB, Marx RG, McCarty EC, Ortiz SF, Zhang AL, Bishop JY. Are Patients Who Undergo the Latarjet Procedure Ready to Return to Play at 6 Months? A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group Cohort Study. Am J Sports Med 2020; 48:923-930. [PMID: 32045268 DOI: 10.1177/0363546520901538] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Latarjet procedure is growing in popularity for treating athletes with recurrent anterior shoulder instability, largely because of the high recurrence rate of arthroscopic stabilization, particularly among contact athletes with bone loss. PURPOSE (1) To evaluate return of strength and range of motion (ROM) 6 months after the Latarjet procedure and (2) to determine risk factors for failure to achieve return-to-play (RTP) criteria at 6 months. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 65 athletes (83% contact sports, 37% overhead sports; mean ± SD age, 24.5 ± 8.2 years; 59 male, 6 female) who enrolled in a prospective multicenter study underwent the Latarjet procedure for anterior instability (29% as primary procedure for instability, 71% for failed prior stabilization procedure). Strength and ROM were assessed preoperatively and 6 months after surgery. RTP criteria were defined as return to baseline strength and <20° side-to-side ROM deficits in all planes. The independent likelihood of achieving strength and motion RTP criteria at 6 months was assessed through multivariate logistic regression modeling with adjustment as needed for age, sex, subscapularis split versus tenotomy, preoperative strength/motion, percentage bone loss, number of prior dislocations, preoperative subjective shoulder function (American Shoulder and Elbow Surgeons and Western Ontario Shoulder Instability Index percentage), and participation in contact versus overhead sports. RESULTS Of the patients, 55% failed to meet ≥1 RTP criteria: 6% failed for persistent weakness and 51% for ≥20° side-to-side loss of motion. There was no difference in failure to achieve RTP criteria at 6 months between subscapularis split (57%) versus tenotomy (47%) (P = .49). Independent risk factors for failure to achieve either strength or ROM criteria were preoperative American Shoulder and Elbow Surgeons scores (per 10-point decrease: adjusted odds ratio [aOR], 1.61; 95% CI, 1.14-2.43; P = .006), Western Ontario Shoulder Instability Index percentage (per 10% decrease: aOR, 0.61; 95% CI, 0.38-0.92; P = .01), and a preoperative side-to-side ROM deficit ≥20° in any plane (aOR, 5.01; 95% CI, 1.42-21.5; P = .01) or deficits in external rotation at 90° of abduction (per 10° increased deficit: aOR, 1.64; 95% CI, 1.06-2.88; P = .02). CONCLUSION A large percentage of athletes fail to achieve full strength and ROM 6 months after the Latarjet procedure. Greater preoperative stiffness and subjective disability are risk factors for failure to meet ROM or strength RTP criteria.
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Affiliation(s)
- Travis L Frantz
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Joshua S Everhart
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Gregory L Cvetanovich
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Andrew Neviaser
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Grant L Jones
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Carolyn M Hettrich
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Brian R Wolf
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
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- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Keith M Baumgarten
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Matthew J Bollier
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Jonathan T Bravman
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - John E Kuhn
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - C Benjamin Ma
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Robert G Marx
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Eric C McCarty
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Shannon F Ortiz
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Alan L Zhang
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Julie Y Bishop
- Investigation performed at Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
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Management of Recurrent Anterior Shoulder Instability After Surgical Stabilization in Children and Adolescents. Curr Rev Musculoskelet Med 2020; 13:164-172. [PMID: 32076937 DOI: 10.1007/s12178-020-09612-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW Recurrent shoulder instability after stabilization is common in pediatric and adolescent athletes. The purpose of this review is to understand the risk factors that lead to failure of primary surgery and management principles in the setting of recurrent instability following surgical stabilization. RECENT FINDINGS Rates of recurrence after primary and revision surgical stabilization remain higher than desirable. Risk factors for failure in include glenoid and humeral bone loss, capsular or ligamentous laxity, and young age though few studies have focused specifically on the adolescent population. Arthroscopic, open, and bone block techniques have been described in this population similar to adults. Failure after a primary shoulder stabilization remains a common problem in adolescents in no small part because a high proportion of these athletes return to high levels of activity. A thorough understanding of the index procedure and patient-specific risk factors for failure are key to successful planning of revision surgery. The current literature does not allow for firm treatment recommendations in individual pediatric or adolescent athletes, but the guiding principles are similar to those in adults. Specifically, all bony and soft tissue pathology should be identified and assessed, with an understanding that simply repeating the steps of the index procedure typically results in poor outcomes, and often an "escalation" of surgical complexity is required at the time of revision. When appropriately indicated, arthroscopic or open soft tissue procedures and Latarjet coracoid transfer can be safely and successfully implemented for revision shoulder stabilization in young athletes.
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Frantz TL, Everhart JS, Cvetanovich GL, Neviaser A, Jones GL, Hettrich CM, Wolf BR, Bishop J, Miller B, Brophy RH, Ma CB, Cox CL, Baumgarten KM, Feeley BT, Zhang AL, McCarty EC, Kuhn JE. What Are the Effects of Remplissage on 6-Month Strength and Range of Motion After Arthroscopic Bankart Repair? A Multicenter Cohort Study. Orthop J Sports Med 2020; 8:2325967120903283. [PMID: 33283013 PMCID: PMC7686606 DOI: 10.1177/2325967120903283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/06/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients who have undergone shoulder instability surgery are often allowed to return to sports, work, and high-level activity based largely on a time-based criterion of 6 months postoperatively. However, some believe that advancing activity after surgery should be dependent on the return of strength and range of motion (ROM). HYPOTHESIS There will be a significant loss of strength or ROM at 6 months after arthroscopic Bankart repair with remplissage compared with Bankart repair alone. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 38 patients in a prospective multicenter study underwent arthroscopic Bankart repair with remplissage (33 males, 5 females; mean age, 27.0 ± 10.2 years; 82% with ≥2 dislocation events in the past year). Strength and ROM were assessed preoperatively and at 6 months after surgery. Results were compared with 104 matched patients who had undergone Bankart repair without remplissage, although all had radiographic evidence of a Hill-Sachs defect. RESULTS At 6 months, there were no patients in the remplissage group with anterior apprehension on physical examination. However, 26% had a ≥20° external rotation (ER) deficit with the elbow at the side, 42% had a ≥20° ER deficit with the elbow at 90° of abduction, and 5% had persistent weakness. Compared with matched patients who underwent only arthroscopic Bankart repair, the remplissage group had greater humeral bone loss and had a greater likelihood of a ≥20° ER deficit with the elbow at 90° of abduction (P = .004). Risk factors for a ≥20° ER deficit with the elbow at 90° of abduction were preoperative stiffness in the same plane (P = .02), while risk factors for a ≥20° ER deficit with the elbow at the side were increased number of inferior quadrant glenoid anchors (P = .003), increased patient age (P = .02), and preoperative side-to-side deficits in ER (P = .04). The only risk factor for postoperative ER weakness was preoperative ER weakness (P = .04), with no association with remplissage (P = .26). CONCLUSION Arthroscopic Bankart repair with remplissage did not result in significant strength deficits but increased the risk of ER stiffness in abduction compared with Bankart repair without remplissage at short-term follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Julie Bishop
- Investigation performed at The Ohio State University Wexner Medical Center,
Department of Orthopaedics, Columbus, Ohio, USA
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Lemme NJ, Kuczmarski AS, Goodman AD, Ready LV, Dickens JF, Owens BD. Management and Outcomes of In-Season Anterior Shoulder Instability in Athletes. JBJS Rev 2019; 7:e2. [DOI: 10.2106/jbjs.rvw.19.00010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Hurley ET, Montgomery C, Jamal MS, Shimozono Y, Ali Z, Pauzenberger L, Mullett H. Return to Play After the Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review. Am J Sports Med 2019; 47:3002-3008. [PMID: 31038983 DOI: 10.1177/0363546519831005] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traumatic anterior shoulder instability is a common clinical problem among athletic populations. The Latarjet procedure is a widely used treatment option to address shoulder instability in high-demand athletes at high risk of recurrence. However, rates and timing of full return to sports have not been systematically analyzed. PURPOSE To systematically review the evidence in the literature to ascertain the rate and timing of return to play and the availability of specific criteria for safe return to play after the Latarjet procedure. STUDY DESIGN Systematic review. METHODS A systematic literature search was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the EMBASE, MEDLINE, and Cochrane Library databases. Eligible for inclusion were clinical studies reporting on return to play after the Latarjet procedure. Statistical analysis was performed by use of SPSS. RESULTS Our review found 36 studies including 2134 cases meeting our inclusion criteria. The majority of patients were male (86.9%), with a mean age of 25.4 years (range, 15-59 years) and a mean follow-up of 83.5 months. The overall rate of return to play was 88.8%, with 72.6% returning to the same level of play. Among collision athletes, the overall rate of return to play was 88.2%, with 69.5% returning to the same level of play. In overhead athletes, the overall rate of return to play was 90.3%, with 80.6% returning to the same level of play. The mean time to return to play was 5.8 months (range, 3.2-8 months). Specific return to play criteria were reported in the majority of the studies (69.4%); time to return to sport was the most commonly reported item (66.7%). CONCLUSION The overall rate of return to play was reportedly high after the Latarjet procedure. However, almost a fifth of athletes returning to sports were not able to return at the same level. Further development of validated criteria for safe return to sports could potentially improve clinical outcomes and reduce recurrence rates.
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Affiliation(s)
- Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Department of Trauma & Orthopaedic Surgery, Dublin, Ireland
| | | | - M Shazil Jamal
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Department of Trauma & Orthopaedic Surgery, Dublin, Ireland
| | | | - Zakariya Ali
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Department of Trauma & Orthopaedic Surgery, Dublin, Ireland
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Owens BD. We Can Do Better. Am J Sports Med 2019; 47:2793-2794. [PMID: 31567028 DOI: 10.1177/0363546519878451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Kasik CS, Rosen MR, Saper MG, Zondervan RL. High rate of return to sport in adolescent athletes following anterior shoulder stabilisation: a systematic review. J ISAKOS 2018; 4:33-40. [PMID: 31044093 DOI: 10.1136/jisakos-2018-000224] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Traumatic anterior shoulder instability remains common for the adolescent athletes. Aim or objective To perform a systematic review on the outcomes and return to sport (RTS) following Bankart repair in adolescent athletes. Evidence review A systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was conducted of studies reporting outcomes following open and/or arthroscopic Bankart repair using modern suture anchors following traumatic anterior shoulder dislocations in adolescent patients (ages 10-19 years). Quality assessment was evaluated with ROBINS-I and MINORS instruments. The outcomes analysed included RTS, timetable to unrestricted activity, recurrent instability and revision surgery. Findings This systematic review identified 11 studies comprising 461 adolescent athletes with a mean age of 15.7 years (range, 11-19 years) and an average follow-up of 48.8 months (range, 22-85.2 months). A total of 392 patients (400 shoulders) underwent arthroscopic Bankart repair, while the remaining 69 patients (69 shoulders) underwent an open procedure. The average MINORS score was 9.6 for non-comparative studies and 17 for comparative studies. ROBINS-I revealed six studies to have a moderate risk of bias, while the remaining five studies presented serious risk of bias. There was an overall 81.5% rate of RTS to preinjury levels of athletic competition at an average of 5.3 months following Bankart repair for traumatic anterior shoulder instability. The overall total mean incidence of recurrent instability was 18.5%, while the mean incidence of revision surgery was 12.1%. Contact athletes had a 31.1% and 13% rate of recurrence and revision surgery, respectively. In comparison, collision athletes were shown to have a 10.4% and 1.4% incidence of recurrent instability and revision surgery, respectively. Conclusions and relevance Adolescent athletes who undergo Bankart repair for traumatic anterior shoulder instability have an 81.5% rate of RTS to preinjury levels of play at an average of 5 months following surgery. The overall total mean incidence of recurrent instability in the adolescent population is 18.5%, while the mean incidence of revision surgery is 12.1%. The results of anterior shoulder stabilisation in contact athletes is much less predictable, with higher reported rates of recurrent instability and revision surgery. Level of evidence Level IV.
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Affiliation(s)
- Connor S Kasik
- Department of Orthopaedic Surgery, McLaren Greater Lansing, Lansing, Michigan, USA
| | - Michael R Rosen
- Department of Orthopaedic Surgery, McLaren Greater Lansing, Lansing, Michigan, USA
| | - Michael G Saper
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, Washington, USA
| | - Robert L Zondervan
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
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Editorial Commentary: Reviewing the Science of Our Unscientific Criteria for Return to Sports After Shoulder Stabilization. Arthroscopy 2018; 34:914-916. [PMID: 29502706 DOI: 10.1016/j.arthro.2017.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 02/02/2023]
Abstract
In contrast to anterior cruciate ligament reconstruction, there is a paucity of primary studies that address the issue of return to play after anterior shoulder stabilization for glenohumeral instability. Most studies focused on clinical outcomes after anterior shoulder stabilization provide little detail on the authors' assessment protocols used in determining return to sport readiness. In fact, many issues germane to the postoperative rehabilitation process (biologic healing, motion recovery, strength recovery, and sport-specific considerations) remain poorly defined, and are not typically addressed using validated shoulder outcomes instruments. Sports medicine surgeons need more objective criteria on which to base their clinical decision making with athletes treated for anterior glenohumeral instability.
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