No difference in return to play seen for NFL players who underwent either open or arthroscopic shoulder stabilization

SEATTLE — The rate of return to play after shoulder stabilization procedures among National Football League players is high, according to research presented at the American Orthopaedic Society for Sports Medicine Annual Meeting that showed no difference in the return rates between players who had either open or arthroscopic repair.

Perspective from John D. Kelly IV, MD

“Open stabilization continues to be a strong treatment option, particularly in collision sports athletes. Recent studies have shown that there are no clinical differences between open and arthroscopic techniques, and we did not find any difference in the return to play between the two categories,” said Matthew J. White, MD, during his presentation.

White and his colleagues from the American Sports Medicine Institute studied the rate of return to play for 60 athletes in the National Football League (NFL) following shoulder stabilization. The researchers defined successful return to play as when an athlete returned to play in at least one regular season NFL game after stabilization. Overall, 11 athletes had open stabilization and 49 athletes had arthroscopic repairs. White said career length and demographics were similar between the groups.

The researchers found that 90% of athletes returned to game play after surgery, with an average return time of 8.6 months. Overall, three of 54 athletes who returned to play missed more than one full season. The investigators discovered no statistically significant differences between athletes who did and those who did not return to play regarding age, number of games played preoperatively and career length. Athletes who underwent open repair had a statistically significant difference in the number of games and seasons played postoperatively, White said. Seven athletes had circumferential labral tears, however, all fully returned to play postoperatively. Their recovery time was 7.9 months and they played for an average of 2.6 seasons.

White said athletes who were selected in the first four rounds of the NFL draft were 7.6 times more likely to return to play after stabilization. – by Kristine Houck

Reference:

White MJ. Paper #2. Presented at: the American Orthopaedic Society for Sports Medicine Annual Meeting; July 10-13, 2014; Seattle.

Disclosure: White has no relevant financial disclosures.

Perspective

John D. Kelly IV, MD

The paper by White and colleagues illustrates several points. First, shoulder stabilization surgery is, by no means, a career-ending event as evidenced by the successful return of 90% of players. Secondly, most cases were performed arthroscopically, lending credence to the notion that most pathologic elements of laxity can be readily addressed with the scope, even in collision athletes. Labral repair and restoration of capsular tension remain the cornerstones of successful instability surgery – whether performed open or arthroscopicially. Finally, the presence of circumferential labral tears in a significant number of patients suggests that open surgery may not be suitable for many athletes. Access to the posterior labrum is difficult, if not impossible, using an open anterior approach.

It would be helpful if the indications for open surgery were delineated and whether any patient underwent prior shoulder surgery before the studied stabilization procedure. The reasons for failure to return to play are not mentioned. Since lower draft picks had less chance of return to play, perhaps other elements, such as skill level or financial incentives, affected the successful return to the National Football League.

John D. Kelly IV, MD

Orthopedics Today Editorial Board Member

Director, Center for Overhead Injuries and Shoulder Preservation

University of Pennsylvania

Philadelphia

Disclosures: Kelly has no relevant financial disclosures.