Recurrent anterior shoulder instability in patients 40-60 years old. Accompanying injuries and patient outcomes of arthroscopic repair

Rotator Cuff Tears are Significantly More Frequent in Recurrent Shoulder Instability Patients With Initial Dislocation at Age 40 or Older

PURPOSE

To investigate and compare the pathologies and clinical outcomes of patients with traumatic anterior shoulder instability who underwent arthroscopic stabilization at 40 years or older between shoulders with initial dislocation before age 40 years and at 40 years or after.

METHODS

Shoulders that underwent arthroscopic stabilization for recurrent traumatic anterior shoulder instability at 40 years or older with a minimum of 2-year follow-up were included. The subjects were divided into 2 groups according to age at initial dislocation after propensity score matching to reduce potential bias: younger than 40 years (group 1) and 40 years or older (group 2). Radiographic findings, pathologies, clinical outcomes, and complications were compared between the groups.

RESULTS

Group 1 included 56 shoulders in 56 patients (26 men and 30 women) with a mean age of 51 years (range, 40-77 years). Group 2 included 28 shoulders in 28 patients (13 men and 15 women) with a mean age of 51 years (range, 40-77 years). Glenoid bone loss was greater in group 1 than in group 2 (P = .004). Rotator cuff tears were more frequently observed in group 2 than in group 1 (P < .001). Both groups showed significant improvement in the West Ontario Shoulder Instability Index score (P < .001 for each) and flexion (P < .001 for each). The recurrence rate was 4% in group 1 and 7% in group 2.

CONCLUSIONS

Rotator cuff tears are significantly more frequent in recurrent shoulder instability patients with initial dislocation at age 40 or older. Arthroscopic stabilization yielded a low recurrence rate and favorable outcomes with a good return-to-sport rate in patients 40 years or older.

LEVEL OF EVIDENCE

Level III, retrospective comparative prognostic trial.

Comparison of the Latarjet Procedure With the Modified Putti-Platt Surgery for Recurrent Anterior Shoulder Dislocation With Respect to Functional Outcome

Introduction Shoulder dislocation is the most common injury encountered in orthopedic outpatient department. The choice of procedure depends on the expertise of surgeons. The objective of this study was to compare the Latarjet procedure with the modified Putti-Platt surgery for recurrent anterior shoulder dislocation in terms of functional outcomes. Materials and methods A quasi-experimental study evaluated 60 patients with recurrent anterior shoulder instability. Patients were assigned to either Latarjet or modified Putti-Platt surgery. Functional outcomes were assessed at six months using the Constant-Murley shoulder score. Results This study encompassed 60 patients (mean age: 23.93±5.88 years) undergoing shoulder procedures. Functional outcomes exhibited a majority of 55% excellent, 35% good, 6.7% fair, and 3.3% poor outcomes. No significant differences in functional outcomes were found between the procedures. Conclusion Both procedures may be viable options for recurrent shoulder instability. The choice may depend on patient factors and surgeon preference. Further research is needed to refine techniques and identify ideal candidates.

Lesion prevalence and patient outcome comparison between primary and recurrent anterior shoulder instability

BACKGROUND

The purpose of this study was to compare lesion prevalence and treatment outcomes in patients with primary and recurrent anterior shoulder instability.

METHODS

Patients who were admitted to the institution with a diagnosis of anterior shoulder instability and who underwent arthroscopic surgery between July 2006 and February 2020 were retrospectively evaluated. Minimum follow-up duration of the patients was 24 months. The recorded data and magnetic resonance imaging (MRI) of the patients were examined. Patients aged ≥40 years, with a history of shoulder region fracture, inflammatory arthritis, a history of epilepsy, multidirectional instability, nontraumatic dislocation, and off-track lesions were excluded from the study. Shoulder lesions were documented and patient outcome evaluation was made with the Oxford Shoulder Score (OSS) and visual analog scale (VAS).

RESULTS

A total of 340 patients were included in the study. The mean age of patients was 25.6 years (±6.49). The recurrent instability group had a significantly higher rate of anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions compared to the primary instability group (40.6% vs. 24.6% respectively) (P = .033). Twenty-five patients (43.9%) had superior labrum anterior and posterior (SLAP) lesions in the primary instability group and 81 patients (28.6%) had SLAP lesions in the recurrent instability group (P = .035). OSS increased for both primary (from 35 [16-44] to 46 [36-48]) (P = .001) and recurrent instability groups (from 33 [6-45] to 47 [19-48]) (P = .001). There was no significant difference between the groups regarding postoperative VAS and OSS scores (P > .05).

CONCLUSIONS

Successful results were obtained in patients younger than 40 years with both primary and recurrent anterior shoulder instability after arthroscopic treatment. ALPSA lesion prevalence was higher whereas SLAP lesion prevalence was lower in patients with recurrent instability. Although the postoperative OSS was comparable between the patient groups, the failure rate was higher in the recurrent instability patients.