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Lateral decubital position shows lower recurrent shoulder instability rate vs. beach chair positon
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LYON, France — Researchers observed a significantly lower recurrent instability rate at an average follow-up of 45 months with arthroscopic anterior shoulder stabilization performed with patients in the lateral decubitus position compared with the beach chair position, according to the results of a systematic literature review and meta-regression analysis presented here.
“Overall, we found that the lateral decubitus position resulted in a recurrent instability rate of 8.5±7.1%, which was significantly reduced compared with the recurrent instability rate of [cases] performed in the beach chair [position], which was 14.6±8.5%,” Rachel M. Frank, MD, said at the International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Biennial Congress, noting that postoperative range of motion and return to activity were unaffected by position.
“Given these results, we have concluded that it may be more difficult for surgeons using the beach chair position to achieve that low anchor position leading to a persistent capsular laxity state, a less stable repair and, ultimately, higher recurrence rates,” Frank said. “However, it should be noted that both positions ultimately resulted in low recurrence rates with excellent clinical outcomes and excellent return to activity, and there are certainly other factors apart from patient positioning that should be considered when we are talking about recurrence.”
Rachel M. Frank
In their literature review, Frank and colleagues searched databases such as PubMed for English studies published between 1990 and 2013 that examined clinical outcomes following shoulder stabilization performed arthroscopically with either suture anchors or tacks that had a minimum patient follow-up of 2 years. Two independent reviewers checked the manuscripts for appropriateness of study inclusion. In addition, a statistician performed a meta-regression analysis of the researchers’ findings.
The researchers identified 64 studies. The 38 beach chair studies included 2,211 shoulders, and the 26 lateral decubitus studies included 3,366 shoulders. Overall, the beach chair and lateral decubitus studies were similar for the average age of patients, length of follow-up and demographics by sex.
After excluding studies performed using tacks, the researchers still found a significantly lower recurrent instability rate for cases using the lateral decubitus position vs. the beach chair position. This finding held when the researchers converted the rate of instability per 100 person-years.
“Overall, excellent outcomes and low recurrence rates can be found with both positions,” Frank said. “However, we found lower recurrence rates following shoulder stabilization in the lateral decubitus position.” – by Gina Brockenbrough, MA
Reference:
Frank RM, et al. Paper #92. Presented at: International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Biennial Congress; June 7-11, 2015; Lyon, France.
Disclosure: Frank reports no relevant financial disclosures.