AOSSM/AANA Specialty Day 2020-Risk Factors for Revision Posterior Shoulder Stabilization in Throwing Athletes

Risk Factors for Revision Posterior Shoulder Stabilization in Throwing Athletes

Pdf Summary

This study by Vaswani et al. investigates risk factors and outcomes for revision arthroscopic posterior capsulolabral repair in throwing athletes experiencing posterior shoulder instability. Prior literature endorses this surgical procedure primarily for throwing and contact athletes, but little is known about risk factors for revision surgery in throwers.<br /><br />The study retrospectively analyzed 112 throwing athletes (mean age 19.1) with at least 2 years of follow-up (average 8.3 years). Inclusion criteria focused on unidirectional posterior instability treated arthroscopically. Outcomes measured included ASES and KJOC scores, pain, stability, range of motion (ROM), strength, and return to play (RTP) rates. MRI assessed glenoid and labral morphology.<br /><br />The revision rate was 8.9%, consistent with previous reports. A key finding was that female athletes had significantly higher revision rates (60% of revisions vs. 23.4% non-revisions, p=0.01). Other hypothesized risk factors such as age, glenoid bone width, glenoid version, and rotator cuff injury were not significant.<br /><br />Post-operatively, revision patients showed improvement in ASES and pain scores but lacked significant gains in KJOC, stability, ROM, and strength compared to non-revisions. RTP to any level was significantly lower after revision (14.3%) versus non-revision (83.6%, p<0.001), although same-level RTP was not statistically different.<br /><br />In conclusion, revision arthroscopic posterior capsulolabral repair in throwing athletes had an 8.9% failure rate at 8.3 years follow-up, with female sex as the only significant risk factor. Revision patients had poorer functional outcomes and dramatically worse overall RTP rates. Age, glenoid morphology, and rotator cuff injury were not linked to revision risk. These findings highlight the challenges of revision surgery and the importance of sex-based differences in managing posterior shoulder instability in throwers.

Keywords

revision arthroscopic posterior capsulolabral repair

throwing athletes

posterior shoulder instability

risk factors for revision surgery

female sex as risk factor

ASES scores

KJOC scores

return to play rates

glenoid morphology

rotator cuff injury