Clinical Outcomes Following Open Anterior Shoulder Stabilisation for Glenohumeral Instability In The Young Collision Athlete.
Crua E., Gatenby GC., Walsh AJ., Monk AP., Stanley JC., Rosenfeldt MP., Twaddle BC., Walsh SJ.
BACKGROUND: Anterior glenohumeral instability occurs most commonly in those aged 15 to 29, with 72% of individuals younger than 22 years suffering recurrent episodes; collision athletes are at particular risk. In the setting of subcritical glenoid bone loss, arthroscopic Bankart repair is widely used despite concerns of recurrent dislocations when compared to open techniques8, 40. Furthermore, indications for bone-block procedures are evolving with the Latarjet procedure being favored amongst recent authors as a primary stabilization method in elite and contact athletes. HYPOTHESIS: To determine the efficacy of open modified Bankart stabilization in treating anterior glenohumeral instability in young collision athletes. METHODS: This was a retrospective review of outcomes of consecutive patients aged 15-20yrs who underwent unilateral or bilateral open stabilization for recurrent anterior glenohumeral instability over a 7-year period (2007-2015). The cohort was selected as recent literature suggests this is the group with the highest re-dislocation rate and poorest outcomes. Outcome assessments included re-dislocation rate, return to sport, pain score, patient related satisfaction scores and Western Ontario Shoulder Instability Index. RESULTS: 60 patients (55 male: 5 female) of mean age 18 (range 15-20yrs) were available for follow-up at 7 years. All but 3 were competitive athletes with 18 competing regionally and 9 internationally; rugby union and rugby league representing the most common sports. 55 out of 60 (92%) have returned to their desired level of sport with 62% of athletes returning to their previous level of competition sport and one retuning at a higher level. Mean postoperative pain score was 2.5/10. Mean time to return to play was 14 months (range 5-48 months). 8/60 shoulders reported re-dislocation (13%), 7 of these being traumatic dislocations following return to high impact sporting activities. At 7 years follow-up 4/60 shoulders (7%) had undergone revision surgery. CONCLUSION: Young collision athletes represent a challenging cohort of instability patients. This study of open modified Bankart in young collision sport athletes revealed excellent outcomes with 92% return to sport and a low revision rate. The results from this cohort rival those of arthroscopic repair. The open procedure described here in this 7 year series represents a robust, reliable technique that could be considered as an alternative to arthroscopic Bankart due to concern for recurrence, while avoiding potential morbidity and complication of bone-block procedures. There is still a role for the open modified Bankart procedure in treating traumatic anterior instability.