Patient Positioning in Arthroscopic Management of Posterior-Inferior Shoulder Instability: A Systematic Review Comparing Beach Chair and Lateral Decubitus Approaches

de, Darren; Sheean, Andrew J.; Morales-Restrepo, Alejandro; Dombrowski, Malcolm E.; Kay, Jeffrey; Vyas, Dharmesh

doi:10.1016/j.arthro.2018.06.057

Cited by 16 publications

(14 citation statements)

References 54 publications

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“…4 However, their analysis of beach-chair revision rates was limited to only 2 smaller studies, reporting revision surgery in only 2 out of 28 patients 7 and 3 out of 31 patients. 2 Last, in the review by de Sa et al, 4 RTS was not reported for any of the included beach-chair studies, while RTS ranged from 72% to 100% for the 12 included lateral decubitus studies. Moeller et al 17 performed a similar systematic review comparing outcomes after posterior shoulder labral repair between 105 patients who underwent surgery in the beachchair position and 626 patients who underwent surgery in the lateral decubitus position.…”

Section: Discussionmentioning

confidence: 99%

“…1 The 2 systematic reviews described above represent the only published studies comparing postoperative outcomes between the beach-chair and the lateral decubitus position for posterior shoulder labral repair. 4,17 These studies highlight several weaknesses in the current literature for posterior shoulder labral repair: (1) a lack of true comparative studies published on the subject; (2) inconsistencies in the reporting of recurrent instability and reoperation across included studies; and (3) a lack of patient-reported outcome comparisons between surgical positions, including no existing comparison regarding postoperative pain. 4,17 Since shoulder instability ranges from subjective apprehension to shoulder dislocation, analyses of recurrent instability in isolation may not present the full picture.…”

Section: Discussionmentioning

confidence: 99%

“…4,17 These studies highlight several weaknesses in the current literature for posterior shoulder labral repair: (1) a lack of true comparative studies published on the subject; (2) inconsistencies in the reporting of recurrent instability and reoperation across included studies; and (3) a lack of patient-reported outcome comparisons between surgical positions, including no existing comparison regarding postoperative pain. 4,17 Since shoulder instability ranges from subjective apprehension to shoulder dislocation, analyses of recurrent instability in isolation may not present the full picture. 6,8 In our current comparative study, we clarified these differences in instability presentation by analyzing redislocation rates in isolation as well as assessing the less-specific outcome of subjective instability.…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review by de Sa et al 4 compared postoperative outcomes for posterior shoulder instability in patients who underwent surgical labral repair in the beach-chair and lateral decubitus positions. Across 25 included studies, 140 patients underwent surgery in the beach-chair, and 945 underwent surgery in lateral decubitus position.…”

Section: Discussionmentioning

confidence: 99%

“…6,10,13 Two systematic reviews have compared postoperative outcomes between patients who underwent posterior shoulder labral repair in the beach-chair versus the lateral decubitus position. 17,4 However, no comparisons of postoperative pain were made in these previous systematic reviews. Also, no comparative studies were included in these reviews, and none have been published on the topic since their publication.…”

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confidence: 99%

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Beach-Chair Versus Lateral Decubitus Positioning for Arthroscopic Posterior Shoulder Labral Repair: A Retrospective Comparison of Clinical and Patient-Reported Outcomes

et al. 2022

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Background: Both beach-chair and lateral decubitus patient positioning are often utilized for shoulder arthroscopy, with each offering its unique advantages and disadvantages. The surgical position is often selected according to each surgeon's preference, with no clear superiority of one position over the other. Purpose/Hypothesis: The purpose was to compare clinical and patient-reported outcomes between patients who underwent arthroscopic posterior labral repair in the beach-chair versus the lateral decubitus position. We hypothesized that patient positioning would not affect clinical and patient-reported outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A list of all patients diagnosed with the Current Procedural Terminology codes 29806 and 29807 between 2015 and 2019 was obtained from the medical records. Patients were only included if arthroscopic posterior labral repair with or without concomitant superior labral anterior to posterior repair was confirmed. Data collected for eligible patients included the number of anchors used, perioperative and postoperative complications, redislocations, subjective instability, reoperation, and revision. Patients were also contacted to complete several patient-reported outcome surveys. Preoperative data, perioperative data, and postoperative outcomes were compared between patients who underwent surgery in the beach-chair versus lateral decubitus position. Results: Overall, 126 patients were included—69 patients underwent surgery in the lateral decubitus position and 57 in the beach-chair position—with a mean follow-up of 2.6 ± 1.7 years. There were no significant pre- or perioperative differences between groups. Rates of postoperative dislocations, subjective instability, reoperations, revisions, all complications, and return to sports rates also did not differ between groups (all, P > .05). Finally, there was no difference between groups regarding postoperative pain, function, and subjective instability scores (all, P > .05). Results of the multivariate regression analysis showed that increased age was a weak independent risk factor for subjective recurrent posterior shoulder instability (odds ratio, 1.04; P = .036). Conclusion: Surgical positioning for arthroscopic posterior shoulder labral repair did not affect postoperative clinical and patient-reported outcomes. Both beach-chair and lateral decubitus position provided good outcomes for posterior shoulder labral repair, with an overall recurrence rate of 8.7%. Increased age was a weak independent risk factor for subjective recurrent instability.

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