Return to Sport After Surgical Treatment for Anterior Shoulder Instability: A Systematic Review

Abdul-Rassoul, Hussein; Galvin, Joseph W.; Curry, Emily J.; Simon, Jason E.; Li, Xinning

doi:10.1177/0363546518780934

Cited by 119 publications

(113 citation statements)

References 38 publications

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“…Whereas some larger studies have reported losses in ER after remplissage, others have reported no statistically significant difference 20, 28, 29, 30, 31, 32, 33. Remplissage continues to have comparable return-to-sport rates to the open Latarjet procedure; however, some concern exists for throwing athletes 34, 35, 36. In their 2016 case series, Garcia et al 36 .…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Double-Pulley Remplissage Using a 2-Portal Technique for Hill-Sachs Lesions in Recurrent Anterior Shoulder Instability

Chakrabarti¹,

Gwosdz²,

Rosinski³

et al. 2019

Arthroscopy Techniques

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Hill-Sachs lesions of the humeral head are associated with recurrent anterior shoulder instability. Arthroscopic double-pulley remplissage has emerged as the leading alternative to the open Latarjet procedure to address recurrent shoulder instability with comparable recurrence rates and favorable complication rates. This Technical Note describes our adaptation of the double-pulley remplissage technique by using 2 portals, with the anterior portal used as the viewing portal and suture passage through the posterior portal. This technique eliminates the need for a lateral percutaneous portal, consequently minimizing operative time and postoperative morbidity. Furthermore, using the anterior portal as the viewing portal allows for direct visualization of the reduction of the infraspinatus into the Hill-Sachs defect. The drawback of this technique is that there is no view of the subacromial space during knot tying.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Double-Pulley Remplissage Using a 2-Portal Technique for Hill-Sachs Lesions in Recurrent Anterior Shoulder Instability

Chakrabarti¹,

Gwosdz²,

Rosinski³

et al. 2019

Arthroscopy Techniques

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“…Although the success of shoulder instability surgery is largely defined by the lack of recurrence, the time to return to sport has emerged as an important and clinically significant metric indicative of success following shoulder stabilization. 1 A recent systematic review of 16 articles 1 reported a return to sport rate of 97.5% and 83.6% after arthroscopic Bankart and open Latarjet procedures, respectively. Furthermore, the time to return to sport was 5.07 months for Latarjet compared with 5.9 months after arthroscopic Bankart.…”

Section: Discussionmentioning

confidence: 99%

“…Although this hypothesis has not been adequately studied, comparative studies have suggested that patients undergoing Latarjet procedures return to sport more quickly than patients undergoing arthroscopic Bankart repair. 1,11 Accordingly, the purpose of the current study was to (1) define the degree of variability across rehabilitation protocols published online for the Latarjet procedure and (2) compare Latarjet rehabilitation programs with published Bankart repair protocols. We hypothesized that the consistency of the programs would vary widely and there would be substantial temporal differences in milestones between Latarjet and Bankart protocols.…”

mentioning

confidence: 99%

A Comparison of Physical Therapy Protocols Between Open Latarjet Coracoid Transfer and Arthroscopic Bankart Repair

Beletsky

Cancienne²,

Manderle

et al. 2020

Sports Health: A Multidisciplinary Approach

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Context: Recent studies examining return to sport after traumatic shoulder instability suggest faster return-to-sport time lines after bony stabilization when compared with soft tissue stabilization. The purpose of the current study was to define variability across online Latarjet rehabilitation protocols and to compare Latarjet with Bankart repair rehabilitation time lines. Evidence Acquisition: Online searches were utilized to identify publicly available rehabilitation protocols from Accreditation Council for Graduate Medical Education (ACGME)–accredited academic orthopaedic surgery programs. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Results: Of the 183 ACGME-accredited orthopaedic programs reviewed, 14 institutions (7.65%) had publicly available rehabilitation protocols. A web-based search yielded 17 additional protocols from private sports medicine practices. Of the 31 protocols included, 31 (100%) recommended postoperative sling use and 26 (84%) recommended elbow, wrist, and hand range of motion exercises. Full passive forward flexion goals averaged 3.22 ± 2.38 weeks postoperatively, active range of motion began on average at 5.22 ± 1.28 weeks, and normal scapulothoracic motion by 9.26 ± 4.8 weeks postoperatively. Twenty (65%) protocols provided specific recommendations for return to nonoverhead sport–specific activities, beginning at an average of 17 ± 2.8 weeks postoperatively. This was compared with overhead sports or throwing activities, for which 18 (58%) of protocols recommended beginning at a similar average of 17.1 ± 3.3 weeks. Conclusion: Similar to Bankart repair protocols, Latarjet rehabilitation protocols contain a high degree of variability with regard to exercises and motion goal recommendations. However, many milestones and start dates occur earlier in Latarjet protocols when compared with Bankart-specific protocols. Consequently, variability in the timing of rehabilitation goals may contribute to earlier return to play metrics identified in the broader literature for the Latarjet procedure when compared with arthroscopic Bankart repair. Strength of Recommendation Taxonomy (SORT): Level C.

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“…[16][17][18] Arthroscopic techniques offer the potential advantage of decreased morbidity, with several studies demonstrating faster return to preoperative function and return to sport. [19][20][21][22] However, many studies have generated concern about arthroscopic stabilization techniques in certain patient populations due to reported higher rates of recurrent instability and decreased time to recurrence when compared to open techniques. [23][24][25][26][27][28] More specifically, increased failure of arthroscopic techniques has been demonstrated in the presence of large glenohumeral bony defects.…”

mentioning

confidence: 99%

Significant Changes in the Diagnosis, Injury Severity and Treatment for Anterior Shoulder Instability Over Time in a U.S. Population

Leland

Parkes

Bernard

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To report the annual incidence of anterior shoulder instability (ASI) diagnosis, injury severity, and surgical stabilization in a U.S. population. Methods An established U.S. geographic database was used to identify patients < 40 years old with diagnoses of ASI from 1994-2016. Medical records were reviewed to obtain patient demographics, histories, imaging results, and surgical details. Age- and sex-specific incidence rates were calculated and adjusted to the 2010 U.S. population. Poisson regression was performed to examine trends by timeline, sex and age. Results The study population consisted of 652 patients with ASI and a mean age of 21.5 years (range, 3.6-39.5). Comparing 2015-2016 to 1994-1999, we found an increase in the number of dislocations (from 1.0-1.9; P = 0.016) and total instability events (from 2.3-3.4; P = 0.041) per patient prior to presentation to a physician. There was a trend in increased diagnosis of bony Bankart and/or Hill-Sachs on MRI over time, with these lesions documented in 96% of patients undergoing MRI in 2015-2018 compared to 52.9% in 1994-1999 ( P < .001). The use of arthroscopic procedures increased and peaked in 2005-2009 (90% of surgical cases performed). The proportion of open Latarjet procedures increased from 2010-2014 (14%) and 2015-2018 (31%). Conclusions The age- and sex- adjusted incidence of ASI diagnosis in a U.S. population from 1994-2016 is comparable to that demonstrated in Canadian and European populations. This study demonstrates an increasing number of instability events prior to surgical evaluation, which may correlate with patients’ more commonly presenting with bone loss and requiring more aggressive surgical treatment or that ASI is being more frequently cared for and documented by present-day orthopedic surgeons. Level of Evidence Level III, cross-sectional study.

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Return to Sport After Surgical Treatment for Anterior Shoulder Instability: A Systematic Review

Cited by 119 publications

References 38 publications

Arthroscopic Double-Pulley Remplissage Using a 2-Portal Technique for Hill-Sachs Lesions in Recurrent Anterior Shoulder Instability

Arthroscopic Double-Pulley Remplissage Using a 2-Portal Technique for Hill-Sachs Lesions in Recurrent Anterior Shoulder Instability

A Comparison of Physical Therapy Protocols Between Open Latarjet Coracoid Transfer and Arthroscopic Bankart Repair

Significant Changes in the Diagnosis, Injury Severity and Treatment for Anterior Shoulder Instability Over Time in a U.S. Population

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