Overhead Athletes Have Comparable Intraoperative Injury Patterns and Clinical Outcomes to Nonoverhead Athletes Following Surgical Stabilization for First-Time Anterior Shoulder Instability at Average 6 Year Follow Up

• Anterior shoulder instability is a common problem affecting young, athletic populations that results in potential career-altering functional limitations. However, little is known regarding the differences in clinical outcomes after operative management of overhead versus nonoverhead athletes presenting with first-time anterior shoulder instability. We hypothesized that overhead athletes would have milder clinical presentations, similar surgical characteristics, and diminished postoperative outcomes when compared to nonoverhead athletes after surgical stabilization following first-time anterior shoulder instability episodes.Patients with first-time anterior shoulder instability events (subluxations and dislocations) undergoing operative management between 2013-2020 were included. Exclusion criteria included multiple dislocations and multidirectional shoulder instability. Baseline demographics, imaging, exam, and intraoperative findings were retrospectively collected. Patients were contacted to collect postoperative patient reported outcomes (PROs) including American Shoulder and Elbow Surgeons (ASES) score, Western Ontario Shoulder Instability (WOSI) score, Brophy activity index, Subjective Shoulder Value (SSV), in addition to return to work/sport rates, recurrent dislocation, and revision rates.A total of 256 patients met inclusion criteria, of which 178 (70%) patients were nonoverhead athletes. Mean age of the entire population was 23.1 years. There was no significant difference in concomitant shoulder pathology nor preoperative range of motion or strength between cohorts. A greater proportion of overhead athletes presented with instability events not requiring manual reduction (defined as subluxations; 64.1% vs. 50.6%; p < 0.001) and underwent arthroscopic surgery (97% vs. 76%, p < 0.001) compared to nonoverhead athletes. A smaller proportion of overhead athletes underwent open soft-tissue stabilization compared to nonoverhead athletes (1% vs. 19%, p < 0.001). Outcome data on 60 patients with average follow-up 6.7 years was available. No significant differences were found between groups with respect to recurrent postoperative instability event rate (13.0% overhead vs. 16.8% nonoverhead) or revision (13.0% overhead vs. 11.1% nonoverhead) rates, ASES, WOSI, BROPHY, SSV, or rates return to work/sport.Overhead athletes who underwent surgery after an initial instability event were more likely to present with subluxations compared to nonoverhead athletes. With limited follow-up subject to biases, this study found no differences in recurrence or revision rates, postoperative PROs, or return to work/sport rates between the overhead and nonoverhead athletes undergoing shoulder stabilization surgery following first-time instability events. While larger prospective studies are necessary to draw firmer conclusions, the findings of this study suggest that overhead athletes can be considered in the same treatment pathway for first-time dislocation as nonoverhead athletes.

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MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Ortopedi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Orthopaedics (hsv//eng)

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