Outcomes of 270° Labral Repair for Combined Shoulder Instability in Active-Duty Military Patients: A Retrospective Study

Abstract

Background:

There is a high prevalence of combined shoulder instability in military patients. Short-term outcomes after 270° labral repair are promising; however, there is a paucity of longer term outcome data in this high-demand group of patients.

Purpose:

To report the midterm outcomes of active-duty military patients treated with 270° labral repair for combined shoulder instability.

Study Design:

Case series; Level of evidence, 4.

Methods:

All consecutive patients between January 2011 and January 2019 who underwent 270° labral repair by the senior surgeon with complete outcome scores were identified. All patients had experienced a shoulder dislocation after a traumatic event and had magnetic resonance imaging and intraoperative findings consistent with combined-type instability. A total of 52 patients met the inclusion criteria for the study, and all were active-duty servicemembers at the time of surgery.

Results:

The mean follow-up was 78.21 months (range, 24-117 months). There was a statistically significant increase in the mean American Shoulder and Elbow Surgeons score (from 44.92 to 89.31; P < .0001), Single Assessment Numeric Evaluation score (from 52.32 to 93.17; P < .0001), and Rowe instability score (from 46.63 to 91.35; P < .0001) from preoperatively to postoperatively. Mean pain decreased significantly as measured by the visual analog scale for pain (from 8.04 to 1.44; P < .0001). Range of motion in forward flexion (from 155.29° to 155.96°; P = .6793), external rotation (from 67.50° to 65.29°; P = .0623), and internal rotation (from T9.58 to T9.56; P = .9650) did not change significantly postoperatively. Outcomes did not differ significantly for patients who underwent surgery on their dominant shoulder versus those who underwent surgery on their nondominant shoulder, nor did outcomes vary with the type of anchor utilized (biocomposite vs all-suture). The overall rate of return to active duty was 92.31%.

Conclusion:

Midterm outcomes in this population of active-duty patients undergoing 270° labral repair for combined shoulder instability demonstrated a statistically and clinically significant improvement in patient-reported outcome scores, a significant decrease in pain, and an overall rate of return to active duty of 92.31%.

Keywords

labral repair combined shoulder instability military shoulder dislocation trans–rotator cuff portal

Get full access to this article

View all access options for this article.

References

Alpert

Verma

Wysocki

Yanke

Romeo

. Arthroscopic treatment of multidirectional shoulder instability with minimum 270 degrees labral repair: minimum 2-year follow-up. Arthroscopy. 2008;24(6):704-711.

Arciero

Wheeler

Ryan

McBride

. Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med. 1994;22(5):589-594.

Bottoni

Wilckens

DeBerardino

, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med. 2002;30(4):576-580.

Costouros

Clavert

Warner

. Trans-cuff portal for arthroscopic posterior capsulorrhaphy. Arthroscopy. 2006;22(10): 1138.e1-1138.e5.

DeBerardino

Arciero

Taylor

. Arthroscopic stabilization of acute initial anterior shoulder dislocation: the West Point experience. J South Orthop Assoc. 1996;5(4):263-271.

Dickens

Kilcoyne

Giuliani

Owens

. Circumferential labral tears resulting from a single anterior glenohumeral instability event: a report of 3 cases in young athletes. Am J Sports Med. 2012;40(1):213-217.

Dickens

Kilcoyne

Haniuk

Owens

. Combined lesions of the glenoid labrum. Phys Sportsmed. 2012;40(1):102-108.

Dumont

Golijanin

Provencher

. Shoulder instability in the military. Clin Sports Med. 2014;33(4):707-720.

Ernat

Yheulon

Shaha

. Arthroscopic repair of 270- and 360-degree glenoid labrum tears: a systematic review. Arthroscopy. 2020;36(1):307-317.

10.

Flint

Pickett

Owens

, et al. Recurrent shoulder instability in a young, active, military population and its professional implications. Sports Health. 2018;10(1):54-59.

11.

Gyftopoulos

Beltran

Bookman

Rokito

. MRI evaluation of bipolar bone loss using the on-track off-track method: a feasibility study. AJR Am J Roentgenol. 2015;205(4):848-852.

12.

Javed

Gheorghiu

Torrance

, et al. The incidence of traumatic posterior and combined labral tears in patients undergoing arthroscopic shoulder stabilization. Am J Sports Med. 2019;47(11):2686-2690.

13.

Kim

Kholinne

, et al. Minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state after arthroscopic rotator cuff repair. Am J Sports Med. 2020;48(11):2650-2659.

14.

Lee

Park

Hyun

Kim

Shin

. Comparison of clinical outcomes and computed tomography analysis for tunnel diameter after arthroscopic Bankart repair with the all-suture anchor and the biodegradable suture anchor. Arthroscopy. 2019;35(5):1351-1358.

15.

Lim

Yap

Campbell

. Hand dominance in traumatic shoulder dislocations. JSES Open Access. 2018;2(2):137-140.

16.

Burkhart

. Triple labral lesions: pathology and surgical repair technique. Report of seven cases. Arthroscopy. 2005;21(2):186-193.

17.

Mazzocca

Cote

Solovyova

, et al. Traumatic shoulder instability involving anterior, inferior, and posterior labral injury: a prospective clinical evaluation of arthroscopic repair of 270 degrees labral tears. Am J Sports Med. 2011;39(8):1687-1696.

18.

Memon

Kay

Cadet

, et al. Return to sport following arthroscopic Bankart repair: a systematic review. J Shoulder Elbow Surg. 2018;27(7):1342-1347.

19.

Kim

Lee

Bae

. Trans-rotator cuff portal is safe for arthroscopic superior labral anterior and posterior lesion repair: clinical and radiological analysis of 58 SLAP lesions. Am J Sports Med. 2008;36(10):1913-1921.

20.

Owens

Campbell

Cameron

. Risk factors for anterior glenohumeral instability. Am J Sports Med. 2014;42(11):2591-2596.

21.

Owens

Dawson

Burks

Cameron

. Incidence of shoulder dislocation in the United States military: demographic considerations from a high-risk population. J Bone Joint Surg Am. 2009;91(4):791-796.

22.

Owens

Duffey

Nelson

, et al. The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med. 2007;35(7):1168-1173.

23.

Owens

Nelson

Duffey

, et al. Pathoanatomy of first-time, traumatic, anterior glenohumeral subluxation events. J Bone Joint Surg Am. 2010;92(7):1605-1611.

24.

Park

Shin

. Minimal clinically important differences and correlating factors for the Rowe score and the American Shoulder and Elbow Surgeons score after arthroscopic stabilization surgery for anterior shoulder instability. Arthroscopy. 2019;35(1):54-59.

25.

Pimple

DaCosta

Clasper

. Management of shoulder instability in a military population. J R Army Med Corps. 2008;154(1):38-40.

26.

Pounder

Hurley

Ali

Pauzenberger

Mullett

. Return to sport following arthroscopic repair of 270 degrees labral tears. Arthrosc Sports Med Rehabil. 2020;2(3):e237-e240.

27.

Provencher

Mannava

Tokish

Rogers

. Traumatic anterior shoulder instability: the US military experience. Am J Orthop (Belle Mead NJ). 2017;46(4):184-189.

28.

Song

Cook

Krul

, et al. High frequency of posterior and combined shoulder instability in young active patients. J Shoulder Elbow Surg. 2015;24(2):186-190.

29.

Stephenson

Hurt

Mair

. Rotator cuff injury as a complication of portal placement for superior labrum anterior-posterior repair. J Shoulder Elbow Surg. 2012;21(10):1316-1321.

30.

Sugaya

. Techniques to evaluate glenoid bone loss. Curr Rev Musculoskelet Med. 2014;7(1):1-5.

31.

Sundaram

Bokor

Davidson

. Rugby union on-field position and its relationship to shoulder injury leading to anterior reconstruction for instability. J Sci Med Sport. 2011;14(2):111-114.

32.

Tokish

McBratney

Solomon

, et al. Arthroscopic repair of circumferential lesions of the glenoid labrum. J Bone Joint Surg Am. 2009;91(12):2795-2802.

33.

Wall

McGonigle

Gill

. Arthroscopic circumferential labral repair for patients with multidirectional instability: a comparative outcome study. Orthop J Sports Med. 2019;7(12):2325967119890103.

34.

Walter

Samim

LaPolla

FWZ

Gyftopoulos

. Imaging quantification of glenoid bone loss in patients with glenohumeral instability: a systematic review. AJR Am J Roentgenol. 2019;212(5):1096-1105. doi: 10.2214/AJR.18.20504

35.

Warth

Briggs

Dornan

Horan

Millett

. Patient expectations before arthroscopic shoulder surgery: correlation with patients’ reasons for seeking treatment. J Shoulder Elbow Surg. 2013;22(12):1676-1681.

36.

Waterman

Owens

Tokish

. Anterior shoulder instability in the military athlete. Sports Health. 2016;8(6):514-519.

37.

Wolfe

Christensen

Mauntel

, et al. A history of shoulder instability in the military: where we have been and what we have learned. Mil Med. 2018;183(5-6):e158-e165.

38.

Yow

Wade

Bedrin

Rue

LeClere

. The incidence of posterior and combined AP shoulder instability treatment with surgical stabilization is higher in an active military population than in the general population: findings from the US Naval Academy. Clin Orthop Relat Res. 2021;479(4):704-708.