Managing Shoulder Instability in the Overhead Athlete

Arguello, Alexandra M.; Till, Sara E.; Reinholz, Anna K.; Okoroha, Kelechi R.; Barlow, Jonathan D.; Camp, Christopher L.

doi:10.1007/s12178-022-09796-x

Cited by 3 publications

(7 citation statements)

References 46 publications

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“…In reviewing the literature, estimated rates of RTS after ASI range from 63% to 92%, depending on the type of sport, often with contact or overhead athletes having lower rates of return. 1,12,28,35 These findings highlight the elevated demands of the athlete's shoulder during competition. Possible explanations for our group of wrestlers being unable to RTW specifically likely stem from the difficulty of surgical stabilization to restore the same level of function and native stability that was able to withstand the demands of the sport.…”

Section: Discussionmentioning

confidence: 81%

“…Shoulder stability is especially important for high-level athletes, including competitive wrestlers who require smooth, stable tracking throughout the full shoulder range of motion and strength when engaging in contact. 1,2,26 However, this young athletic cohort remains at risk for recurrence despite treatment. With respect to ASI, Ranalletta et al 27 followed a cohort of 56 athletes (22 contact and 34 collision) after arthroscopic shoulder stabilization and observed a 14.7% rate of recurrent shoulder instability in the collision sport group (eg, rugby, boxing, ice hockey, American football, and wrestling) compared with 0% in the contact sport cohort (eg, soccer and field hockey).…”

Section: Discussionmentioning

confidence: 99%

“…In athletes, shoulder instability surgery (SIS) has become a common treatment option for those who sustain traumatic shoulder instability. 1,8,10,14 Current investigations regarding surgical treatment for shoulder instability are often focused on anterior shoulder instability (ASI) in the military population or athletes participating in mainstream sports. 1,8,10,14 Subsequently, there are generally fewer studies evaluating the effect of SIS in wrestlers.…”

Section: In-depthmentioning

confidence: 99%

“…1,8,10,14 Current investigations regarding surgical treatment for shoulder instability are often focused on anterior shoulder instability (ASI) in the military population or athletes participating in mainstream sports. 1,8,10,14 Subsequently, there are generally fewer studies evaluating the effect of SIS in wrestlers. 2,33 Furthermore, given the high rate of injuries and need for operative intervention, additional studies are needed to effectively counsel wrestlers who sustain shoulder instability.…”

Section: In-depthmentioning

confidence: 99%

mentioning

confidence: 99%

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Outcomes of Shoulder Instability Surgery in Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 5 Years’ Mean Follow-up

Marigi,

Lamba,

Boos

et al. 2024

Am J Sports Med

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Background: Wrestling is a physically demanding sport with young athletes prone to traumatic shoulder instability and a paucity of data evaluating the results of shoulder instability surgery (SIS). Purpose: To assess reoperation rates, patient-reported outcomes, and return to wrestling (RTW) after SIS in a cohort of competitive wrestlers. Study Design: Case series; Level of evidence, 3. Methods: All competitive wrestlers with a history of shoulder instability and subsequent surgery at a single institution between 1996 and 2020 were identified. All directions of shoulder instability (anterior shoulder instability [ASI], posterior shoulder instability [PSI], and traumatic multidirectional shoulder instability [TMDI]) were analyzed. Exclusions included revision SIS and <2 years of follow-up. Athletes were contacted for determination of complications, RTW, and Western Ontario Shoulder Instability Index scores. Results: Ultimately, 104 wrestlers were included with a mean age at initial instability of 16.9 years (range, 12.0-22.7 years), mean age at surgery of 18.9 years (range, 14.0-29.0 years), and a mean follow-up of 5.2 years (range, 2.0-22.0 years). A total of 58 (55.8%) wrestlers were evaluated after a single shoulder instability event, while 46 (44.2%) sustained multiple events before evaluation. ASI was the most common direction (n = 79; 76.0%), followed by PSI (n = 14; 13.5%) and TMDI (n = 11; 10.6%). Surgical treatment was most commonly an arthroscopic soft tissue stabilization (n = 88; 84.6%), with open soft tissue repair (n = 13; 12.5%) and open bony augmentation (n = 3; 2.9%) performed less frequently. RTW occurred in 57.3% of wrestlers at a mean of 9.8 months. Recurrent instability was the most common complication, occurring in 18 (17.3%) wrestlers. Revision SIS was performed in 15 (14.4%) wrestlers. Across the entire cohort, survivorship rates free from recurrent instability and revision surgery were 90.4% and 92.5% at 2 years, 71.9% and 70.7% at 5 years, and 71.9% and 66.5% at 10 years, respectively. Preoperative recurrent instability was an independent risk factor for postoperative recurrent instability (hazard ratio, 3.8; 95% CI, 1.33-11.03; P = .012). Conclusion: Competitive wrestlers with multiple dislocations before initial clinical evaluation were 3.8 times more likely to experience postoperative recurrent instability. Patients should be counseled that despite SIS, only 57.3% returned to wrestling after surgery.

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