Prevalence and Risk Factors of Glenoid Bone Loss in Combined Shoulder Instability in Young, Active-Duty Military Patients

Comparison of Glenoid Bone Loss After Unidirectional Versus Combined Shoulder Instability in a Military Population

Background

While glenoid bone loss (GBL) after anterior shoulder instability correlates with poor functional outcomes, the specific effects of GBL in posterior and combined-type shoulder instability remain poorly characterized, especially in a high-risk military population.

Purpose/Hypothesis

The purpose of this study was to compare GBL between unidirectional anterior or posterior instability versus combined-type instability in active-duty servicemembers. It was hypothesized that total GBL and GBL in the direction of instability would be greater in those with combined-type instability compared with unidirectional instability.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Active-duty servicemembers who underwent shoulder stabilization surgery between January 2010 and December 2019 were eligible for inclusion. Patients with multidirectional instability, concomitant rotator cuff tears, osteochondritis dissecans of the glenoid or humeral head, superior labral anterior-posterior tears, biceps pathologies, and humeral avulsion of the glenohumeral ligament were excluded. Patients were grouped according to direction of instability (anterior, posterior, or combined), and patient characteristics, instability characteristics, suture anchor use, and GBL were compared between the 3 cohorts.

Results

In total, 117 patients met the study inclusion criteria. The mean patient age was 29 years, 89.7% were male, the dominant extremity was involved in 63.2%, 65.8% attributed their injuries to a singular traumatic event, and the mean follow-up was 7.9 years. There was no significant difference regarding patient characteristics, injury mechanism, or follow-up time between the 3 cohorts. As compared with the combined-type instability cohort, mean anterior GBL was greater in the anterior instability cohort (8.00% ± 4.40% vs 4.98% ± 5.26% for combined; P = .012), while mean posterior GBL was greater in the posterior instability cohort (7.44% ± 4.54% vs 4.86% ± 5.69% for combined; P = .024). There was no significant difference in mean total GBL between the combined-type (9.84% ± 7.82%) and either of the unidirectional cohorts (anterior: 8.00% ± 4.40% [P = .231]; posterior: 7.44% ± 4.54% [P = .082]).

Conclusion

GBL in the direction of instability was found to be significantly greater in the unidirectional versus combined-type instability cohorts.

Over 89% of Patients Return to Work After Undergoing Arthroscopic or Open Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review

PURPOSE

To better define the rate of return to work in patients undergoing Latarjet surgery for anterior shoulder instability.

METHODS

A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane Center Register of Controlled Trials, and Scopus were queried in October 2023 with the following keywords: ((latarjet) OR (anterior shoulder instability)) AND ((work) or (compensation)). Articles were included if they reported return to work in patients (including military members) undergoing Latarjet surgery for traumatic anterior shoulder instability with bone loss and were written in English. This study was registered in Prospero (ID blinded).

RESULTS

Six studies reporting on 419 shoulders were included in the review. Five studies reported on patients in the general population, and 1 reported on military members. Mean age ± standard deviation of patients ranged from 23.1 ± 5.8 to 32.0 ± 12.3 years. Moreover, there were 286 primary Latarjet procedures, 131 revision Latarjet procedures, and 2 unspecified as primary or revision surgery. Mean glenoid bone loss ranged from 14.5% to 22.9%. Return-to-work rates ranged from 89.1% to 100%, with 2 studies reporting all patients were able to return to work. Among military members, 89.1% were able to return to duty. Mean time to return to work ranged from 8.69 to 34.8 weeks after surgery. Four studies also reported return to sport, which ranged from 60.9% to 100%. Mean time for returning to sport varied between 10.0 and 35.2 weeks after the Latarjet procedure.

CONCLUSIONS

Patients with anterior shoulder instability who undergo an arthroscopic or open Latarjet procedure can expect high rates of return to work and sport. All studies reported return-to-work rates over 89%, with 89.1% of military members able to return to duty.

LEVEL OF EVIDENCE

Level IV, systematic review of Level III and Level IV studies.