Summary

This study found that while both sexes improve after Arthroscopic Anatomic Glenoid Reconstruction (AAGR) for shoulder instability, males tend to have worse pre-operative outcomes but greater post-operative improvements in strength and range of motion compared to females.

Abstract

Introduction

Surgical treatment for shoulder instability is gaining popularity, prompting an interest in predictors of surgical success such as age, participation in contact sports, and number of dislocations. Though research has shown that sex-specific differences exist following arthroscopic Bankart repair, sex is often overlooked as a factor for post-surgical expectations. Arthroscopic Anatomic Glenoid Reconstruction (AAGR) is a recently developed technique for addressing shoulder instability with glenoid bone loss. There has been no research on sex-based differences following AAGR, which uses a distal tibia allograft to reconstruct the glenoid. This study aimed to explore sex-specific outcomes of patients who underwent AAGR.

Methods

This is a retrospective analysis of 109 patients (males = 86; females = 32) who underwent AAGR for recurrent anterior shoulder instability between 2013-2021. Data collected included demographics, pre- and post-operative Western Ontario Shoulder Instability (WOSI) Index, EQ-5D scores, strength data (reported in pounds of force), range of motion (ROM) data, plain radiographs, CT scans, post-operative complications, and recurrence.

Results

There was no difference in age or BMI between groups. Rate of recurrent instability did not differ between sexes (p=0.206). Males consistently demonstrated lower average patient-reported outcome scores, though both groups reported improvements in WOSI and EQ-5D scores from pre- to post-operative (p<0.001). Larger deficits in ROM were observed pre-operatively in male patients, who demonstrated significant improvements in ROM in both flexion and abduction from pre- to post-operative. Comparatively, females maintained consistent ROM across all time-points. Males demonstrated loss of strength in flexion, abduction, internal and external rotation from pre- to six-months post-operative, but surpassed baseline strength values by one year. Females improved strength in flexion and abduction from baseline to one year.

Conclusions

Male patients tend to have worse patient-reported outcomes and more functional deficits pre-operatively, however they demonstrate better improvement in strength and range of motion post-operatively than their female counterparts. Sex-specific differences are evident following AAGR surgery, and they should be considered by surgeons and discussed with patients to manage expectations and outcomes.