Summary

Excellent outcomes can be achieved following open anterior stabilisation for glenohumeral instability in young collision athletes.

Abstract

Introduction

Anterior glenohumeral instability occurs most commonly in those aged 15 to 29, with the highest rate of redislocation in individuals younger than 22 years; collision athletes are at particular risk. In the setting of bone loss <25% glenoid diameter, arthroscopic Bankart repair is widely used despite overwhelming evidence of recurrent dislocations when compared to open techniques. Furthermore, indications for bone-block procedures are evolving with the Laterjet procedure being favoured amongst recent authors as a primary stabilization method in elite and contact athletes.
The purpose of this study was to determine the efficacy of open anterior shoulder stabilization (OASS) in treating anterior glenohumeral instability in young collision athletes.

Methods

This was a retrospective review of outcome of consecutive patients aged 15-20yrs who underwent unilateral or bilateral OASS for recurrent anterior glenohumeral instability over a 7-year period (2007-2015). The cohort was selected as recent literature suggests this is the group with the highest re-dislocation rate and poorest outcomes. Outcome assessments included re-dislocation rate, return to sport, pain score (VAS), patient related satisfaction scores and Western Ontario Shoulder Instability Index.

Results

60 patients (52 male:8 female) of mean age 18 (range 15-20yrs) were available for follow-up at 7 years. All were competitive athletes with 22 competing regionally and 8 internationally; rugby union and rugby league representing the most common sports. 56 out of 60 (93%) have returned to their desired level of sport with 62% of athletes returning to their previous level of competition sport and one retuning at a higher level. Mean post-operative pain score was 2.5/10. Mean time to return to play was 14 months (range 5-48 months). 15 shoulders had further subluxation/instability symptoms with 9 of these being traumatic dislocations during high impact sporting activities. At 7 years follow-up 4/60 shoudlers (7%) had undergone revision surgery.

Conclusions

This study of Open Anterior Shoulder Stabilisation in young collision sport athletes revealed excellent outcomes with 93% return to sport and a low revision rate. The results from this cohort rivals those of arthroscopic repair. OASS provides an excellent alternative surgical option between arthroscopic repair and the Laterjet procedure.