Original Article
Arthroscopic Stabilization of the Shoulder in Adolescent Athletes Participating in Overhead or Contact Sports

https://doi.org/10.1016/j.arthro.2011.08.302Get rights and content

Purpose

To investigate the outcome of arthroscopic capsular repair for shoulder instability in an active adolescent population participating in overhead or contact sports.

Methods

We identified 67 patients (aged 13 to 18 years) with post-traumatic recurrent shoulder instability for inclusion in the study from our computer database. Of these patients, 65 (96%) were available for clinical review. There were 44 male and 21 female patients, with a mean age of 16 years at the time of surgery. All patients participated in overhead or contact sports at a competitive level. Arthroscopic capsulolabral repair was performed after at least 6 months of failed nonoperative treatment. The mean follow-up was 63 months. Shoulder range of motion and functional outcomes were measured preoperatively and postoperatively with Single Assessment Numeric Evaluation (SANE), Rowe, and American Shoulder and Elbow Surgeons (ASES) scores. Furthermore, type of sport, time until surgery, and number of dislocations were analyzed from our database to find any correlation with the recurrence rate.

Results

At final follow-up, the mean SANE score was 87.23% (range, 30% to 100%) (preoperative mean, 46.15% [range, 20% to 50%]); the mean Rowe score was 85 (range, 30 to 100) (preoperative mean, 35.9 [range, 30 to 50]); and the mean ASES score was 84.12 (range, 30 to 100) (preoperative mean, 36.92 [range, 30 to 48]). The mean forward flexion and external rotation with the arm at 90° abduction did not change from preoperative values; 81% of the patients returned to their preinjury level of sport, and the rate of failure was 21%. The recurrence rate was not related to the postoperative scores (P = .556 for SANE score, P = .753 for Rowe score, and P = .478 for ASES score), the number of preoperative episodes of instability (P = .59), or the time from the first instability episode to the time of surgery (P = .43). There was a statistically significant relation (P = .0021) between recurrence and the type of sport practiced. Recurrence rate was related to the type of sport practiced.

Conclusions

Arthroscopic stabilization is a reasonable surgical option even in an adolescent population performing sports activities. However, it must be emphasized to the patients and their relatives that the recurrence rate that could be expected after an arthroscopic procedure is higher than in the adult population.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Patient Selection

In this retrospective cohort study, patients were identified from a database of 650 consecutive arthroscopic capsulolabral repairs for anterior recurrent shoulder instability, performed between September 2002 and December 2005. As defined by the American Academy of Pediatrics, 126 adolescents aged between 13 and 18 years were identified. Patients with significant bone loss of the glenoid (>25%), as evaluated arthroscopically according to Burkhart et al.,14 and patients with connective tissue

Results

All the patients indicated that a traumatic injury was responsible for the first dislocation that occurred during sports activities. In 53 patients there was a history of shoulder dislocation, whereas the other 12 patients described a history consistent with shoulder subluxation; the mean time elapsed from the time of injury to surgery was 17.6 months (range, 9 to 28 months).

No intraoperative or postoperative surgical complications were reported in this group of patients. In all 65 patients, at

Discussion

Many articles in the literature have analyzed the effectiveness of arthroscopic capsulorrhaphy in athletes participating in contact or overhead sports,2, 10, 11 few articles have analyzed the same procedure in an adolescent population,4, 6, 7, 12, 13 and only 1 article included both these groups; however, the level of sport involvement was not clearly defined.3

Ide et al.11 used a suture anchor technique for recurrent GH instability in a selected high-risk athletic population (21 contact, 25

Conclusions

Arthroscopic stabilization is a reasonable surgical option even in an adolescent population performing sports activities. However, it must be emphasized to the patients and their relatives that the recurrence rate that could be expected after an arthroscopic procedure is higher than in the adult population.

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The authors report no conflict of interest.

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