Summary

Patients undergoing ACRR for recurrent anterior shoulder instability maintained significant improvement in functional outcomes at a minimum follow-up of 20 years, along with a rate of recurrent instability of 27.6%.

Abstract

Background

Although short- to mid-term clinical data of patients undergoing arthroscopic capsulolabral revision repair (ACRR) for recurrent anterior shoulder instability are promising, evidence pertaining to long-term functional, sports- and work-related outcomes is scarce. The purpose was to provide prospectively collected long-term functional outcomes, sports activity, and work ability of patients undergoing ACRR for recurrent anterior shoulder instability. It was hypothesized that patients would maintain significant functional improvement along with a sufficient sports activity and work ability at a minimum follow-up of 20 years.

Methods

Patients who underwent ACRR between 09/1998 to 08/2003 and had a minimum follow-up of 20 years were analyzed. Functional outcome measures included Rowe and Constant-Murley (CM) scores, as well as the visual analogue scale (VAS) for pain, which were collected preoperatively, at short-term follow-up (minimum 2 years) and at a minimum final follow-up of 20 years. The minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated for the Rowe Score. The Single Assessment Numeric Evaluation (SANE) and Simple Shoulder Test (SST) scores were only collected at final follow-up. Return to sports (RTS) and work (RTW), including sports and work level and discipline, were evaluated using a custom sports and work ability assessment tool.

Results

Twenty-nine patients (mean age at surgery: 28.6 ± 9.8 years) were included in the study, with a mean follow-up of 21.1 ± 1.5 years (range: 20 – 24 years). The rate of recurrent instability was 27.6% (n=8), while 10.3% (n=3) underwent revision surgery. Younger age at surgery was significantly associated with failing after revision procedure (p=0.042). The Rowe and CM score each significantly improved at both the minimum 2-year and minimum 20-year follow-up, when compared to preoperatively (p<0.001, respectively). Neither the CM (p=0.055) nor the Rowe (p=0.958) score differed significantly between the minimum 2-year and 20-year follow-up. For the Rowe score, 79.3% achieved MCID at the minimum 2- and 20-year follow-ups, 51.7% surpassed the PASS at 2 years, and 48.3% did so at 20 years. At the minimum 20-year follow-up, VAS pain at rest was 0.6 ± 1.6, VAS pain during exercise was 1.1 ± 1.4, and SST was 89.3 ± 13.5. The patients’ sport-specific capabilities significantly declined at the minimum 2-year and 20-year follow-up compared to pre-injury levels. The amount of activity (p=0.022) and the mobility (p=0.021) significantly declined from the minimum 2-year to the 20-year follow-up. At final follow-up, most patients reported their working ability as “excellent” (71%) and “good” (24%).

Conclusion

Patients undergoing ACRR for recurrent anterior shoulder instability maintained significant improvement in functional outcomes at a minimum follow-up of 20 years, along with a rate of recurrent instability of 27.6%. Further, patients achieved a favorable postoperative sport activity and work ability.