Trends of shoulder instability surgery in Finland: a nationwide register study

Upper Limb Strength and Performance Deficits after Glenohumeral Joint Stabilization Surgery in Contact and Collision Athletes

PURPOSE

The primary aim was to identify and quantify differences in interlimb asymmetry magnitudes across a battery of upper extremity strength and performance tests at 4 and 6 months after glenohumeral joint stabilization surgery shoulder stabilization in contact and collision athletes compared with an un-injured group. A secondary aim was to investigate if identified asymmetry magnitudes changed from 4 to 6 months after glenohumeral joint stabilization surgery. The third aim was to explore associations within the different performance and strength variables.

METHODS

Fifty-six male contact and collision sport athletes who had had undergone unilateral glenohumeral joint stabilization were tested at 4 and 6 months after surgery. An un-injured control group ( n = 39 for upper extremity performance tests, n = 47 for isokinetic dynamometry) were tested on a single occasion. Three upper extremity force platform-based performance tests and angle-specific concentric internal and external isokinetic shoulder rotational strength were assessed, and interlimb asymmetries were compared between the two groups.

RESULTS

At 4 months after surgery, the glenohumeral joint stabilization group demonstrated significantly higher absolute interlimb asymmetry values than the un-injured group for almost all the performance test variables. In the ballistic upper-body performance tests, the glenohumeral joint stabilization group achieved only half the body elevation reached by the un-injured (counter-movement push-up jump height ( η2 = 0.50) and press-jump jump height ( η2 = 0.39)). At 6 months after surgery, absolute interlimb asymmetries reduced for the performance test variables, but some asymmetry persisted. The glenohumeral joint stabilization group had significantly greater absolute interlimb asymmetries for five out the eight isokinetic variables.

CONCLUSIONS

Contact and collision athletes who may be cleared to return to sport at 4 to 6 months after glenohumeral joint stabilization surgery shoulder stabilization continue to demonstrate upper limb strength and performance deficits when compared with their un-injured limb and their un-injured counterparts.

Surgical Intervention Following a First Traumatic Anterior Shoulder Dislocation Is Worthy of Consideration

Up to 60% of patients experience recurrence after a first traumatic anterior shoulder dislocation (FTASD), which is often defined as having experienced either dislocation or subluxation. Thus surgical intervention after FTASD is worthy of consideration and is guided by the number of patients who need to receive surgical intervention to prevent 1 redislocation (i.e., number needed to treat), (subjective) health benefit, complication risk, and costs. Operative intervention through arthroscopic stabilization can be successful in reducing recurrence risk in FTASD, as has been shown in multiple randomized controlled trials. Nevertheless, there is a large "gray area" for the indication of arthroscopic stabilization, and it is therefore heavily debated which patients should receive operative treatment. Previous trials showed widely varying redislocation rates in both the intervention and control group, meta-analysis shows 2% to 19% after operative and 20% to 75% after nonoperative treatment, and redislocation rates may not correlate with patient-reported outcomes. The literature is quite heterogeneous, and a major confounder is time to follow-up. Furthermore, there is insufficient standardization of reporting of outcomes and no consensus on definition of risk factors. As a result, surgery is a reasonable intervention for FTASD patients, but in which patients it best prevents redislocation requires additional refinement.

Arthroscopic Bankart versus open Latarjet as a primary operative treatment for traumatic anteroinferior instability in young males: a randomised controlled trial with 2-year follow-up

Objectives

To compare the success rates of arthroscopic Bankart and open Latarjet procedure in the treatment of traumatic shoulder instability in young males.

Design

Multicentre randomised controlled trial.

Setting

Orthopaedic departments in eight public hospitals in Finland.

Participants

122 young males, mean age 21 years (range 16–25 years) with traumatic shoulder anteroinferior instability were randomised.

Interventions

Arthroscopic Bankart (group B) or open Latarjet (group L) procedure.

Main outcome measures

The primary outcome measure was the reported recurrence of instability, that is, dislocation at 2-year follow-up. The secondary outcome measures included clinical apprehension, sports activity level, the Western Ontario Shoulder Instability Index, the pain Visual Analogue Scale, the Oxford Shoulder Instability Score, the Constant Score and the Subjective Shoulder Value scores and the progression of osteoarthritic changes in plain films and MRI.

Results

91 patients were available for analyses at 2-year follow-up (drop-out rate 25%). There were 10 (21%) patients with redislocations in group B and 1 (2%) in group L, p=0.006. One (9%) patient in group B and five (56%) patients in group L returned to their previous top level of competitive sports (p=0.004) at follow-up. There was no statistically significant between group differences in any of the other secondary outcome measures.

Conclusions

Arthroscopic Bankart operation carries a significant risk for short-term postoperative redislocations compared with open Latarjet operation, in the treatment of traumatic anteroinferior instability in young males. Patients should be counselled accordingly before deciding the surgical treatment.

Trial registration number

NCT01998048.