Background
Although shoulder pain and dysfunction are common in overhead throwing athletes, shoulder surgery is uncommon among elite athletes including professional baseball players. One of the most common pathologies of shoulder dysfunction in overhead throwing athletes is “internal impingement. The pathophysiology of symptomatic internal impingement is multifactorial, involving scapular dyskinesis, posterior capsular contracture, and anterior instability. Since Jobe and Bradley stated that most pervasive disorders in young athletes are due to a lack of shoulder stability, several authors have reported the importance of stability and satisfactory results in overhead throwing athletes after stabilization of the shoulder. However, the optimal surgical treatment for internal impingement with anterior instability of the shoulder remains controversial. This study evaluated overhead throwing athletes’ preliminary outcomes following anterior glenohumeral capsular ligament reconstruction for internal impingement with anterior instability of the shoulder.
Methods
Twenty overhead athletes (all male; mean age, 23.1±8.9 years) with internal impingement and anterior instability managed via anterior glenohumeral capsular ligament reconstruction were examined. The mean follow-up period was 21.3±9.6 months. Anterior glenohumeral capsular ligament reconstruction was performed with a knee hamstring autograft for balanced stability and laxity with two major targets: to prevent hyper-angulation and translation in horizontal abduction, and to mimic the individual arm cocking position at the final decision of tension. Preoperative and final follow-up evaluations were performed using Jobe’s postoperative grading system; the Kerlan–Jobe Orthopaedic Clinic Overhead Athletes Shoulder and Elbow Score (KJOC); Disabilities of the Arm, Shoulder and Hand (DASH) sports module; plain radiographs; and magnetic resonance imaging.
Results
Jobe’s postoperative grading system score, KJOC, and the DASH sports module score improved significantly from 29.0 ± 16.4, 28.0 ± 9.0, and 80.7 ± 16.3 points preoperatively to 87.1 ± 14.1, 77.2 ± 15.1, and 19.1 ± 17.8 points postoperatively, respectively (P < .001, .0025, < .001, respectively). Both clinical and imaging evaluations revealed improved internal impingement with anterior instability after anterior glenohumeral capsular ligament reconstruction. The mean external rotation at abduction significantly decreased from 109 preoperatively to 101 postoperatively. At follow-up, 16 of the 20 athletes (80.0%) returned to their prior competitive level. Plain radiographs and magnetic resonance imaging revealed no obvious loosening of the graft or screws.
Conclusions
Anterior glenohumeral capsular ligament reconstruction resulted in preferable clinical outcomes for overhead throwing athletes with symptomatic internal impingement with anterior instability. Stabilization of the glenohumeral joint with autografting of the knee hamstring may thus represent a solution for internal impingement with anterior instability in overhead throwing athletes.