Risk Factors and Outcomes of Revision Arthroscopic Posterior Capsulolabral Reconstruction in

Contact Athletes

Justin W. Arner, MDSachidhanand Jayakumar, BS

Elan Golan, MDDharmesh Vyas, MDJames P Bradley, MD

DISCLOSURES

James Bradley, MDreceives royalties from Arthrex

Introduction

Literature endorses arthroscopic posterior capsulolabral repair in athletes

lContact / collision athleteslOverhead athletes

Arner JW, et al. Arthroscopic Stabilization of Posterior Shoulder Instability Is Successful in American Football Players. Arthroscopy. 2015

McClincy MP et al. Posterior Shoulder Instability in Throwing Athletes: A Case-Matched Comparison of Throwers and Non-Throwers. Arthroscopy, 2015.

Risk Factors for Posterior Instability • Owens B, et al AJSM 2013

• Most sig risk factor for developing posterior instability is increased glenoid retroversion

• 1 deg of inc retroversion is 17% risk of subsequent post shoulder instability

• Mauro C, McClincy M, Bradley JP AJSM 2016• 200 post repairs decreased bony width was predictive of poorer

outcomes not bone version

• Hines A, Tokish J AJSM 2018• Decreased return to full duty if <13.5% bone loss (RR 1.8) (22% of

pts) BUT outcome scores & revision rates were NO different

Hypothesisl Contact athletes who require revision

arthroscopic posterior unidirectional capsulolabral repair will have:l Poorer outcomes and return to play at 2 yr

min f/u

l Risk factors for revision will include:l younger age, decreased glenoid bone width,

and fewer anchors

Methodsl Risk factors evaluated:

l Age, gender, intra-op severity of injury, level of sport

l MRI:l Bone widthl Labral widthl Cartilage versionl Labral versionl Bone version

l Post op outcomes evaluated:l Return to sport

l Any level vs. same levell Worthwhileness of

original surgery

l Revision rate

ResultsRevisions Non-revisions

Total 11 111Age 18.7 17.4Gender

Male 11 102Female 0 9

Mean f/u (yrs) 12.0Level

Professional 0 4College 1 29High school 10 71

Recreational 0 7

Results: Revision Rate

Revision rate for posterior shoulder instability in contact athletes= 5.9%

ResultsNot risk factors for requiring revision surgery:l Age (p = 0.10)l Gender (p = 0.326) l Level of sport (p = 0.381)

l Isolated labral injury (p = 0.349) l Isolated capsular injury (p = 0.683)

MRI Results

Revision Non-revisionBone width* 26.4 29.2Labral width 31.9 31.6Cartilage version 10.4 11.1Labral version 10.6 11.7Bone version 9.9 10.4*Significant difference (p = 0.005)

Return to Play

l Same level: p < 0.001l Revision = 16.7% l Non-revision = 72.1%

l Overall: p < 0.001l Revision = 50% l Non-revision = 93.7%

Conclusionsl Revision rate = 5.9%

l The only significant risk factor for requiring revision surgery in contact athletes was smaller glenoid bone width.

l Return to play was significantly worse in those who required revision surgery.

References1. Arner JW, McClincy MP, Bradley JP. Arthroscopic Stabilization of Posterior Shoulder Instability Is Successful in American Football Players. Arthrosc J Arthrosc Relat Surg. 2015;31(8):1466-1471. doi:10.1016/j.arthro.2015.02.022.2. Bradley JP, Arner JW, Jayakumar S, Vyas D. Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair. Am J Sports Med. 2018;46(10):2457-2465. doi:10.1177/0363546518785893.3. Bradley JP, McClincy MP, Arner JW, Tejwani SG. Arthroscopic Capsulolabral Reconstruction for Posterior Instability of the Shoulder A Prospective Study of 200 Shoulders. Am J Sports Med. 2013;41(9):2005-2014. doi:10.1177/0363546513493599.4. Chang ES, Greco NJ, McClincy MP, Bradley JP. Posterior Shoulder Instability in Overhead Athletes. Orthop Clin North Am. 2016;47(1):179-187. doi:10.1016/j.ocl.2015.08.026.5. DeLong JM, Jiang K, Bradley JP. Posterior Instability of the Shoulder A Systematic Review and Meta-analysis of Clinical Outcomes. Am J Sports Med. 2015;43(7):1805-1817. doi:10.1177/0363546515577622.6. Frank RM, Romeo AA, Provencher MT. Posterior Glenohumeral Instability: Evidence-based Treatment. J Am Acad Orthop Surg. 2017;25(9):610-623. doi:10.5435/JAAOS-D-15-00631.7. Fronek J, Warren RF, Bowen M. Posterior subluxation of the glenohumeral joint. J Bone Joint Surg Am. 1989;71(2):205-216.8. Hawkins RJ, Koppert G, Johnston G. Recurrent posterior instability (subluxation) of the shoulder. J Bone Joint Surg Am. 1984;66(2):169-174.9. Hines A, Cook JB, Shaha JS, et al. Glenoid Bone Loss in Posterior Shoulder Instability: Prevalence and Outcomes in Arthroscopic Treatment. Am J Sports Med. 2018;46(5):1053-1057. doi:10.1177/0363546517750628.10. Hurley JA, Anderson TE, Dear W, Andrish JT, Bergfeld JA, Weiker GG. Posterior shoulder instability: Surgical versus conservative results with evaluation of glenoid version. Am J Sports Med. 1992;20(4):396-400. doi:10.1177/036354659202000405.11. Mauro CS, McClincy MP, Bradley JP. Effect of Glenoid Version and Width on Outcomes of Arthroscopic Posterior Shoulder Stabilization. Am J Sports Med. 2016;44(4):941-947. doi:10.1177/0363546516631738.12. Nacca C, Gil JA, Badida R, Crisco JJ, Owens BD. Critical Glenoid Bone Loss in Posterior Shoulder Instability. Am J Sports Med. 2018;46(5):1058-1063. doi:10.1177/0363546518758015.13. Owens BD, Campbell SE, Cameron KL. Risk Factors for Posterior Shoulder Instability in Young Athletes. Am J Sports Med. 2013;41(11):2645-2649. doi:10.1177/0363546513501508.14. Provencher MT, LeClere LE, King S, et al. Posterior Instability of the Shoulder Diagnosis and Management. Am J Sports Med. 2011;39(4):874-886. doi:10.1177/0363546510384232.