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Background
The high demands to the glenohumeral joint and the violent shoulder blows experienced during martial arts (MA) could compromise return to sports and increase the recurrence rate after arthroscopic stabilization for anterior shoulder instability in these athletes.
Purpose
To report the functional outcomes, return to sports, and recurrenc...
Context in source publication
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Objectives:
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Patients and methods:
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Purpose
This study evaluates outcomes of a consistent arthroscopic stabilization technique for recurrent posterior instability.
Methods
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Citations
... Given the devastating professional and financial ramifications of failed instability surgery in the professional athlete [35], any advantage offered through open stabilization over an arthroscopic approach may supersede cosmetic or post-operative pain concerns. Further, individuals engaged in combat sports (e.g., wrestling, mixed martial arts (MMA), etc.) may also benefit from open Bankart repair and capsular shift, given the supraphysiologic loads placed on the shoulder and high rates of recurrence after arthroscopic stabilization [36]. In the senior author's practice, high-level contact, collision, and combat athletes are offered open stabilization procedures. ...
Purpose of Review
The purpose of this review is to describe the evolution of the open labral repair with capsular shift, including the current role of this procedure in the treatment of shoulder instability.
Recent Findings
Currently, a subset of patients – high-level collision/contact sport athletes, patients with significant inferior or multi-directional instability, and individuals with failed arthroscopic Bankart repair without bone loss – may experience benefit from undergoing open Bankart repair with capsular shift. Surgeons performing open stabilization can benefit from instrumentation and anchors developed to assist with arthroscopic techniques.
Summary
Understanding the history and evolution behind the procedure not only allows the surgeon to appreciate principles behind an arthroscopic approach, but also permits the utilization of an open approach when required by patient pathology and risk factors.
... Return to the same level of sport following arthroscopic Bankart repair was also reported in the literature, with rates ranging from 60% to 65%. 7,29,30 Five patients received additional surgery for screw removal after 1 year of unexplained shoulder pain and discomfort, with good results. 31 Screw removal after a Latarjet procedure has been proven for pain relief, as the screws can cause impingement of the subscapularis muscle anteriorly. ...
Purpose
To analyze the rate of return to play, changes in athletic level, and recurrence rate and to report subjective outcomes in a series of rugby players with anterior shoulder instability who underwent an arthroscopic Latarjet procedure.
Methods
A multicenter retrospective study done in 2 centers on rugby players who were operated on between January 2011 and December 2020 was performed. Rugby players who underwent arthroscopic Latarjet procedure for anterior shoulder stabilization with a minimum follow-up period of 2 years were included. Rugby players were grouped according to their competitive level in their country (recreational, regional, national, and international). Data collected included return to sport after surgery, time to return to rugby, athletic level before and after surgery, patient satisfaction, and subjective scores. Recurrence and apprehension rates were also evaluated.
Results
A total of 73 subjects were included. Mean age at time of surgery was 23 ± 5 years. Mean duration of follow-up was 5 ± 2.6 years. Eighty-four percent of rugby players returned to rugby within a mean period of 6.6 months. Initial athletic level was a significant factor (P = .012) for not returning to sport, with 67% of patients who initially played at a recreational level not returning to rugby and 33% of patients who initially played at a regional league level not returning. All national and international players returned to play. Of the 12 non-returning rugby players, only 30% did not return because of their shoulder. Mean Subjective Shoulder Value was 90 ± 9%. Recurrence rate was 7%.
Conclusions
Arthroscopic Latarjet procedure proved its efficacy in managing recurrent anterior shoulder instability in rugby players. Return to play was achieved in almost all cases, with low recurrence rates. Despite high global return to the same level of sport, the higher the level of competition, the harder it is for rugby players to resume sport at the same level.
Level of Evidence
Level IV, therapeutic case series.
... 8 During a match or training, athletes may collide with each other or with the ground repeatedly with a great deal of force. 7,9 As a result of the continuing forces and loads applied to the shoulder, recurrence rates are directly impacted. 7 Therefore, this subcategory of patients should receive special attention when undergoing ABR. ...
... 3 Third, recurrence rates are often reported in a global manner without further analysis by sport. 9 These inconsistencies make it difficult to provide precise counseling to athletes regarding their expectations after ABR. Thus, it is still necessary to understand which factors are influencing recurrence variation to improve our treatment and advice to patients. ...
... On the basis of the inclusion and exclusion criteria, 516 studies were excluded from consideration. This left 35 articles describing the outcomes of 2,591 patients who underwent ABR for the treatment of glenohumeral instability 3,5,9, (Fig 1). Specifically, there were 21 case series, 11 cohort studies, and 3 case-control studies, with a median sample size of 50 (range, . ...
Purpose:
The primary purpose of this systematic review was to describe and compare recurrence rates in collision (CC) sports following an arthroscopic Bankart repair (ABR). The secondary purpose was to compare the recurrence rates in CC vs non-collision athletes following ABR.
Methods:
We followed a pre-specified protocol registered in PROSPERO (registration number CRD42022299853). A search of the literature was performed in January 2022 in the electronic databases MEDLINE, EMBASE, CENTRAL, and clinical trials records. Clinical studies (levels of evidence 1-4) that evaluated recurrence after ABR in CC athletes with a minimum follow-up of 2 years postoperative were included. We assessed the quality of the studies using the ROBINS-I tool, and we described the range of effects using synthesis without meta-analysis (SWiM) and the certainty of the evidence using GRADE.
Results:
We identified 35 studies, which included 2488 athletes. The studies had heterogeneous definitions of recurrence and classifications of sports. The rate of recurrence following ABR varied significantly among studies between 3%-51%, I2=84.9% (35 studies and 2488 participants). The range was on the higher end for participants younger than 20 years old (range 11% to 51%, I2=81.7%) compared to those older (range 3% to 30% I2=54.7%). Recurrent rates also varied by recurrence definiton ( I2=83.3%) and within and across categories of CC sports ( I2=83.8%). CC athletes had higher recurrence rates when compared to non-collision athletes (7%-29% vs. 0-14%, I2=29.2%, 12 studies with 612 participants). Overall, the risk of bias for all the included studies were determined to be moderate. The certainty of the evidence was low due to study design (level III-IV evidence), study limitations, and inconsistency.
Conclusion:
There is high variability in the recurrence rates reported after ABR according to the different types of CC sports, ranging from 3% to 51%. Moreover, variations in recurrence among CC sports were observed with ice hockey players being in the upper range, while field hockey players were in the lower range. Finally, CC athletes showed higher recurrence rates when compared to non-collision athletes.
... 7,11,19 Furthermore, return-to-sports rates have been shown to vary among athletes in contact sports after shoulder instability surgery. 28,30 However, the factors that prevent an athlete from returning to sports after shoulder instability surgery are still unclear and have not been thoroughly studied. ...
Background
Literature is scarce regarding the influence of psychological readiness on return to sports after shoulder instability surgery.
Purpose
To evaluate the predictive ability of the Shoulder Instability–Return to Sport after Injury (SIRSI) score in measuring the effect of psychological readiness on return to sports and to compare it between athletes who returned to sports and athletes who did not return to sports.
Study Design
Cohort study; Level of evidence, 2.
Methods
A prospective analysis was performed of patients who underwent an arthroscopic Bankart repair or a Latarjet procedure between January 2019 and September 2020. Psychological readiness to return to play was evaluated using the SIRSI instrument. Preoperative and postoperative functional outcomes were measured by the Rowe, Athletic Shoulder Outcome Scoring System, and Western Ontario Shoulder Instability Index scores. The predictive validity of the SIRSI was assessed by the use of receiver operating characteristic (ROC) curve statistics. The Youden index was calculated and used to determine a SIRSI score cutoff point that best discriminated psychological readiness to return to sports. A logistic regression analysis was performed to evaluate the effect of psychological readiness on return to sports and return to preinjury sports level.
Results
A total of 104 patients were included in this study. Overall, 79% returned to sports. The SIRSI had excellent predictive ability for return-to-sport outcomes (return to sports: area under ROC curve, 0.87 [95% CI, 0.80-0.93]; return to preinjury sports level: area under ROC curve, 0.96; [95% CI, 0.8-0.9]). A cutoff level of ≥55 was used to determine whether an athlete was psychologically ready to return to sports and to return to preinjury sports level (Youden index, 0.7 and 0.9, respectively). Of those who returned to sports, 76.8% were psychologically ready to return to play, with a median SIRSI score of 65 (interquartile range, 57-80). In comparison, in the group that did not return to sports, only 4.5% achieved psychological readiness with a median SIRSI score of 38.5 (interquartile range, 35-41) ( P < .001). Regression analysis for the effect of SIRSI score on return to sports was performed. For every 10-point increase in the SIRSI score, the odds of returning to sports increased by 2.9 times. Moreover, those who did not achieve their preinjury sports level showed poorer psychological readiness to return to play and SIRSI score results.
Conclusion
The SIRSI was a useful tool for predicting whether patients were psychologically ready to return to sports after glenohumeral stabilization surgery. Patients who returned to sports and those who returned to their preinjury sports level were significantly more psychologically ready than those who did not return. Therefore, we believe that the SIRSI score should be considered along with other criteria that are used to decide whether the patient is ready to return to sports.
... Several previous studies have reported that contact/collision and overhead sports are associated with inferior return to sports rates than non-contact sports. [22][23][24][25] Petrera et al 26 reported a 73% rate of return to sports in their collision athletes. Cho et al 27 reported only a 65% rate of pre-injury levels in collision athletes. ...
Numerous studies have reported high rates of return to sports following arthroscopic Bankart repair (ABR) However, there is enormous controversy regarding the optimal management of these patients in the postoperative period. Controversy issues include rehabilitation, criteria for returning to sports, and the specific management of each athlete according to the sport they practice. Even though there are several rehabilitation protocols published in the literature, wide variability exists concerning the key elements of rehabilitation after an ABR. Regarding criteria for return to sports, there is a wide variation across the different published studies. The type of sports has been shown to affect an athlete's decision to return to sports. Nevertheless, most research is evaluated by classifications that cluster different sports into categories that may have other influences in return to sports when analyzed separately. Finally, in addition to physical readiness, the athlete's psychological state is crucial for returning to sports. However, the contribution of psychological readiness to an athlete's return to sports after shoulder instability surgery remains uncertain and unexplored.
... Rehabilitation after surgical intervention for shoulder instability can be broadly characterized by a few main phasesdprotection, endurance, strength, then return to sport. [61][62][63][64][65] Sling immobilization semioperatively varies significantly across the literature from 0 to 2 weeks, 65,66 3 weeks, 62 4 weeks, 61,67 or even up to 6 weeks. 68 After immobilization, athletes can begin active-assisted and active ROM exercises around 4 to 6 weeks semioperatively. ...
... 68 After immobilization, athletes can begin active-assisted and active ROM exercises around 4 to 6 weeks semioperatively. [63][64][65]67,69,70 Between 6 to 12 weeks semioperatively, strengthening and gradual progression to sport-specific exercises is initiated 61,64,65,[67][68][69]71 and can extend to 18þ weeks semioperatively. 63 ...
... 68 After immobilization, athletes can begin active-assisted and active ROM exercises around 4 to 6 weeks semioperatively. [63][64][65]67,69,70 Between 6 to 12 weeks semioperatively, strengthening and gradual progression to sport-specific exercises is initiated 61,64,65,[67][68][69]71 and can extend to 18þ weeks semioperatively. 63 ...
Shoulder and elbow injuries during athletic participation are very common and may require operative intervention if refractory to conservative care. In recovering from these upper extremity injuries, proper postoperative rehabilitation and setting reasonable expectations regarding return to play are very important. This review article focuses on the most common surgically treated shoulder and elbow injuries, including rotator cuff tears, SLAP tears, anterior and posterior shoulder instability, and elbow ulnar collateral ligament tears. Rates of return to play after surgical intervention are encouraging in most professional and recreational athletes but are highly dependent on the severity of injury, as well as the demands and position in sport. Real-world strategies for staged successful rehabilitation are presented and discussed.
... This result was also found by some authors, 5,10,26,36,37 who moreover stated that the type of sport was an important influencing factor. 9,14,15,23,25,26,28 In addition, Bessière et al found that athletes' RTS rate was lower not only after arthroscopic labral reconstruction but also after the Latarjet procedure. Our study is, as far as we know, the first to specifically evaluate the postoperative results of competitive handball players, providing sport-specific data about a shoulder stabilization procedure. ...
Background:
Although numerous studies have reported on the redislocation rate and functional results of arthroscopic treatment for anterior shoulder instability in athletes, they have not disclosed outcomes in the high-risk group of elite handball players.
Purpose:
To investigate the postoperative outcomes of arthroscopic treatment for anterior shoulder instability as well as the return-to-sport (RTS) rate in professional handball players.
Study design:
Case series; Level of evidence, 4.
Methods:
Involved in this study were 44 competitive handball players (47 shoulders) who underwent arthroscopic anterior capsulolabral reconstruction between 2010 and 2018 and had a minimum follow-up of 24 months. After surgery, patients completed a questionnaire that collected Rowe and American Shoulder and Elbow Surgeons (ASES) scores and RTS data, and we compared these results with their preoperative scores. We also compared results according to the following subgroups: true dislocations versus recurrent subluxations, younger (<20 years) versus older (≥20 years) age, male versus female sex, and shorter versus longer duration of instability. Statistical analysis included the paired-samples t test and nonparametric Fisher exact test.
Results:
The mean follow-up period was 52.2 ± 21.4 months. There were 4 shoulders (9%) with recurrent instability. There were significant preoperative to postoperative improvements in the mean Rowe score (from 45.2 to 91.8) and mean ASES score (from 70.6 to 95.7) (P < .001 for both). Overall, the RTS rate was 83%, and 64% (30/47 shoulders) were able to return to their preinjury level. The RTS rate was significantly lower in the younger players than in the older players (46% vs 86%, respectively; P = .005).
Conclusion:
The study results indicated that handball players with anterior shoulder instability can be treated using arthroscopic labral reconstruction successfully and 83% of the athletes were able to RTS activity. The handball players aged ≥20 years returned to their preinjury level of sport at a higher rate than did those aged <20 years.
... Cho et al. 6 reported only 65% rate of complete return to preinjury levels in collision athletes. Similarly, Ranalletta et al. 21 showed that only 60% of martial arts athletes could achieve the same level before surgery. Furthermore, all of these results were reported in a general way, not considering the specific return to each specific sport separately. ...
Background
The purpose of our study was to investigate the influence of the different rugby playing positions on return to sports, functional outcomes, and recurrences after an arthroscopic Bankart repair.
Methods
A total of 88 rugby players were treated for anterior shoulder instability in our institution between 2010 and 2018. Functional outcomes, return to sports, recurrences, complications, and revisions rates were evaluated according to the playing position.
Results
Overall, 73.8% of the patients returned to rugby and 60% returned at the same level as before the injury. The tight forwards and outside backs experienced a significant decrease in their competitive level after surgery, and showed the lowest functional outcomes. The tight forwards and outside backs showed a statistically significant increase in recurrence and revision rates, and an OR for recurrence of 12.8 and 9.6, respectively.
Discussion
The playing position significantly influenced return to sports and recurrences after an arthroscopic Bankart repair in competitive rugby players. Specifically, the tight forwards and outside backs have returned to a lower level than they had before surgery, showed the lowest functional outcomes, and a significant increase in recurrences and revisions rates than the other groups.
... 2,3 However, some studies published in the last decade have shown that in some risk subgroups, the results with Bankart repair are even unfavorable when patients have a glenoid bone deficit of less than 20%. [4][5][6][7][8] These risk subgroups mainly include contact and collision athletes, forced overhead athletes, and patients with previous failed Bankart repairs. [4][5][6][7][8] The main problem in these high-risk patients is the high recurrence rate, which can vary between 15% and 51%. ...
... [4][5][6][7][8] These risk subgroups mainly include contact and collision athletes, forced overhead athletes, and patients with previous failed Bankart repairs. [4][5][6][7][8] The main problem in these high-risk patients is the high recurrence rate, which can vary between 15% and 51%. [4][5][6][7][8] Furthermore, some authors have demonstrated a significant decrease in functional outcomes with isolated capsulolabral repair in athletes with only 13.5% to 20% glenoid bone deficit, even in patients who did not sustain a recurrence of their instability. ...
... [4][5][6][7][8] The main problem in these high-risk patients is the high recurrence rate, which can vary between 15% and 51%. [4][5][6][7][8] Furthermore, some authors have demonstrated a significant decrease in functional outcomes with isolated capsulolabral repair in athletes with only 13.5% to 20% glenoid bone deficit, even in patients who did not sustain a recurrence of their instability. 9,10 Due to the high risk of recurrences and the possibility of obtaining suboptimal results with isolated Bankart repair, we have decided, since 2010, to treat high-risk patients in our institution by means of glenoid reconstruction with Latarjet surgery. ...
Purpose
To analyze return to sports, functional outcomes, and complications following the Latarjet procedure in competitive athletes with anterior glenohumeral instability and glenoid bone loss <20%.
Methods
All the included patients were operated between 2010 and 2016. The inclusion criteria were competitive athletes with anterior glenohumeral instability, a glenoid bone defect <20% who participated in contact sports, forced overhead sports, or had a previous failed Bankart repair and had a minimum 2 years’ follow-up. Return to sports, range of motion (ROM), the Rowe score, and the Athletic Shoulder Outcome Scoring System score were used to assess functional outcomes. Complications and bone consolidation were also evaluated.
Results
A total of 65 athletes were included in the study. The mean follow-up was 53 months (±13), and the mean age was 23.9 years (range, 16-31 years). Overall, 94% were able to return to sports and 84% returned at the same level. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe and Athletic Shoulder Outcome Scoring System scores showed statistical improvement after operation (P < .001). No significant difference in shoulder ROM and functional scores was found between primary and revision cases. The total complication rate was 11% and the revision rate was 1.5% The recurrence rate was 4.6%. The bone block healed in 95% of the cases.
Conclusions
In high-risk competitive athletes with anterior glenohumeral instability and glenoid bone loss <20%, the Latarjet procedure resulted in excellent functional outcomes, with most of the patients returning to sports and at the same level they had before injury with a low rate of recurrences
Level of Evidence
Therapeutic case series; Level of evidence, IV
... A total of 7 (11%) studies 18,24,39,42,70,76,101 used a generic health questionnaire in combination with a diseasespecific PRO tool, whereas 22 (35%) studies § § used a visual analog scale to assess pain in combination with a disease-specific and/or generic health questionnaire. Further, 8 (13%) studies 15,22,37,42,72,73,85,86 recorded the results of a sport-specific questionnaire in combination with a disease-specific and/or generic health questionnaire. No studies included in our review used a PRO tool to assess psychosocial factors. ...
Background:
Athletic endeavor can require the "athletic shoulder" to tolerate significant load through supraphysiological range and often under considerable repetition. Outcome measures are valuable when determining an athlete's safe return to sport. Few data are available to guide a clinician's choice from the variety of measures available.
Purpose:
To describe the use of quantifiable objective outcome measures and patient-reported outcome tools after glenohumeral joint stabilization, specifically in an athletic population. The secondary aim of our study was to assess whether the method of measurement used was clearly described and standardized to aid clinical interpretation.
Study design:
Systematic review; Level of evidence, 4.
Methods:
A systematic search of MEDLINE, Scopus, SPORTDiscus, and Web of Science databases was performed in December 2018 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. After the application of selection criteria, a full review of identified papers, and screening of reference lists, a total of 62 studies were included in the review. All studies were independently appraised for quality, predefined data fields were populated and cross-checked for accuracy, and results were then summarized from these data fields.
Results:
Of the 62 included studies, 94% used a quantifiable objective clinical outcome. A majority (85%) of the studies measured range of motion, 21% recorded muscle strength, 5% measured electromyographic activity, 5% examined shoulder kinematics, and 3% assessed joint proprioception after surgery. However, only 18% of the studies clearly described a standardized method of measuring the outcome. Nearly all (95%) of the studies used at least 1 patient-reported outcome measure. The Rowe score was most commonly used (35%).
Conclusion:
We must standardize and clearly describe the use of quantifiable objective outcome measures to aid clinical interpretation. A concerted effort should also be made to standardize the use of patient-reported outcome tools after shoulder stabilization in the athletic population.
