Returning to sport after surgical treatment of posterior shoulder instability is highly likely, according to a new study…but a return to preinjury performance level? Not as certain.
After Posterior Shoulder Instability Surgery, What Then?
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“Nonoperative management of posterior shoulder instability is still considered by many the first-line treatment; however, when nonoperative treatment has failed, patients can be offered surgical management. Arthroscopic and open soft tissue repair techniques for posterior instability include repair of the posterior labrum and plication or thermal shrinkage of the posteroinferior capsule,” wrote the researchers of “Return to Sport After Surgical Management of Posterior Shoulder Instability: A Systematic Review and Meta-analysis.”
“Posterior shoulder instability accounts for a small proportion of all shoulder instability, although it can affect athletes of all types, from contact to overhead athletes. Surgical treatment is quite successful in these patients; however, the literature reports a wide range of rates of return to sport.
They hypothesized in their study which was published online on May 11, 2021 in The American Journal of Sports Medicine that the return to sport rate after surgical stabilization would be high.
The systematic review included studies from the Embase, PubMed and MEDLINE databases up until April 2020. Primary outcomes included return to sport and functional outcomes.
Thirty-two studies with a total of 1,100 patients (1,153 shoulders) were included in the final analysis. The mean age was 22.8 years and the mean follow-up was 43.2 months.
The researchers reported a pooled rate of return to any level of sport of 88% (95% CI, 84%-92%, I2 = 68.7%). The pooled rate of return to the preinjury level however was 68% (95% CI, 60%-76%, I2 = 79%).
In a comparison between return to sport rates for contact and throwing athletes, the rate was higher for contact athletes (94% vs. 88%)
“Surgical management of posterior shoulder instability resulted in a high rate of return to sport, as well as significant pain reduction and functional improvement in most patients. However, only two-thirds of athletes can return to their preinjury levels of sport,” they wrote.
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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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