A new cohort study suggests that combined labral tears and injured capsules are predictors of poor patient outcomes after shoulder instability surgery.
Labral Tears, Injured Capsules Predictors of Poor Outcomes
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Secondary#shoulderinstabilitysurgery#adolescents
The study, “What Are The Predictors of Poor Patient-Reported Outcomes Following Shoulder Instability Surgery?” presented at the 2020 PRiSM 7th Annual Meeting [Pediatric Research in Sports Medicine].
The researchers evaluated which factors predict unfavorable patient-reported outcomes (PROs) in adolescent patients after shoulder instability surgery using American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE) and Patient Acceptable Symptom State (PASS) responses before and after surgery.
They hypothesized that poor outcomes are associated with adolescent males, bone loss, larger labral tears, and articular cartilage injury.
Included in the study were 268 patients 13 years and older who underwent the surgery at one institution between 2015 and 2017. Twelve surgeons performed the procedures. Any patients with isolated posterior labral tears and prior ipsilateral shoulder surgery were excluded.
About 75% of the patients completed follow-up procedures—2.5% of these patients needed revision surgery; 81% responded yes to PASS. And these patients had a mean 31-point improvement in ASES and 34-point improvement in SANE scores.
Overall, combined labral tears (anterior/inferior plus superior or posterior tears) and injured capsules were associated with greater likelihood of responding “No” to PASS and have lower ASES and SANE scores (p ≤ 0.05). Age, sex, Hill-Sachs lesions, and grade III/IV articular cartilage injuries were not associated with variations in any PROs.
The researchers wrote, “In this prospective cohort, patients largely approve of their symptom state at one year or greater following shoulder instability. A PASS “Yes” response occurred in 81% of patients and correlated to a clinically and statistically significant improvement in ASES and SANE scores.”
They added, “Combined labral tears and injured capsules were negative prognosticators across PROs, whereas age, sex, and Hill-Sachs lesions were not.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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