Athletes with Shoulder Instability can Benefit from Arthroscopy

Highlights:

Arthroscopic stabilization is performed on athletes with fewer incidents of pre-operative shoulder instability
Shoulder instability or dislocation often results in loss of function and pain in the shoulder
Performing arthroscopy on young athletes after the first dislocation is highly recommended, as it can bring better outcomes

Arthroscopic stabilization, a procedure to correct shoulder dislocations has better outcomes if patients are properly selected and if the surgery is performed on athletes with fewer incidents of pre-operative instability, according to researchers who presented their work at the American Orthopedic Society for Sports Medicine's (AOSSM) Annual Meeting in San Diego.

Arthroscopic procedures are a leading surgical option due to advantages of requiring less operative time, shorter hospitalization, and less postoperative narcotic use.

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‘Young athletes with shoulder dislocation have high recurrence rates and lower rates of return to sport following arthroscopic stabilization. Arthroscopy might be most beneficial to athletes when performed after the first dislocation.’

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In a study conducted by Frank A. Cordasco, MD, MS and his colleagues from the Hospital for Special Surgery in New York City, about 67 athletes between the ages of 14 and 20 (19 females and 48 males who averaged 17 years of age) with shoulder instability were treated with arthroscopic anterior stabilization performed in the beach chair position by a single surgeon.

The primary results determined were the rates at which revision surgery had to be performed and return to sports at a minimum follow-up of 2 years.

The researchers found that

The rate of revision surgery was very low, at 6%
The percent of athletes who returned to the sport at an average of 7 months following surgery was 82%
Forty-two (63%) of the 67 athletes had experienced only one dislocation and only a few had more than two instability episodes
All of the six recurrences occurred in males

"Our study highlights the importance for young athletes with shoulder instability, undergoing a thorough preoperative evaluation to determine the number of instability events and to obtain appropriate advanced imaging when the significant bone loss is suspected. Each pre-operative instability episode can result in greater degrees of bone loss, which results in higher failure rates following arthroscopic shoulder stabilization," said Cordasco.

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Cordasco says that undergoing pre-operative evaluation can determine the best procedure to select from the menu of operations available to manage shoulder instability. The types of operations include:

Arthroscopic stabilization
Open stabilization and
Bone augmentation, such as Latarjet reconstruction

When the young athlete chooses the appropriate selection from the menu, the resulting outcomes will allow this high-risk group to predictably and reproducibly get back in the game.

This study demonstrates that the revision surgery rate is low and the return to sport rate is high when an arthroscopic stabilization is performed on the high-risk young athlete who presents with fewer episodes of pre-operative instability; also the rates might be the best if surgery is done after the first dislocation.

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Athletes are more prone to shoulder dislocations, where the upper arm bone gets removed from the cup-shaped socket.

Cordasco said that more research has to be conducted for this challenging group of young, active high-risk athletes to continue to improve the outcomes.

References:

Andrea Pantalone, Daniele Vanni, Matteo Guelfi, Michele Di Mauro, Michele Abate, and Vincenzo Salini., "Arthroscopic treatment of shoulder instability in professional athletes" Muscles Ligaments Tendons J 2017 Oct-Dec; 6(4): 440–444. doi: 10.11138/mltj/2016.6.4.440

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Source-Medindia