AOSSM/AANA Specialty Day 2020-Return to Sport Following Shoulder Stabilization_ As Good as We Think

Return to Sport Following Shoulder Stabilization_ As Good as We Think_

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This presentation by Dr. Scott Rodeo at the AOSSM/AANA 2020 Specialty Day reviews outcomes of shoulder stabilization surgeries, particularly in athletes involved in contact and collision sports. Historically, open shoulder stabilization was the gold standard, showing predictable stability restoration with high rates of return to play and low recurrence of dislocation. A randomized trial comparing open and arthroscopic techniques found open repair resulted in significantly lower recurrence, especially in younger males with Hill-Sachs lesions.<br /><br />Early arthroscopic Bankart repairs initially had suboptimal outcomes, particularly in patients under 25 or with ligamentous laxity or large Hill-Sachs lesions, though improved techniques and better patient selection have enhanced results. Meta-analyses indicate that while earlier data favored open surgery for lower recurrence, more recent studies show no significant difference between open and arthroscopic stabilization in terms of failure rates, though arthroscopic methods preserve external rotation better.<br /><br />For contact and collision athletes, return to sport after surgery remains suboptimal. Arthroscopic stabilization yields better return-to-play rates than nonoperative treatment after anterior shoulder instability, though recurrence rates remain high in adolescent contact athletes, especially under age 16. The open Latarjet procedure shows variable outcomes in high-risk athletes, with about half returning to pre-injury levels and some experiencing recurrent instability or decreased activity.<br /><br />Dr. Rodeo’s current management algorithm advises considering surgery for young athletes in contact/collision sports after a first dislocation, noting risk factors for recurrence (young age, contact sports, ligamentous laxity, prior instability, bone loss). Rehabilitation and return to play within the same season may be suitable for older or recreational athletes, with surgery recommended for early recurrence. Arthroscopic repair is preferred for first-time dislocators with good tissue quality, while open procedures are considered for contact athletes due to higher recurrence risk.<br /><br />In summary, while surgical techniques have improved, return to sport after shoulder stabilization in contact/collision athletes remains challenging, with patient selection and tailored surgical approach critical for optimal outcomes.

Keywords

shoulder stabilization

athletes

contact sports

collision sports

open surgery

arthroscopic repair

return to play

recurrence rates

Latarjet procedure

Hill-Sachs lesions