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Preoperative condition seen as key in return to baseline function after anterior shoulder instability

Issue: August 2016

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COLORADO SPRINGS, Colo. — Rather than surgical factors, data presented here indicate patient preoperative condition is the most important factor in return to baseline function in the short-term period following anterior shoulder instability.

Carolyn M. Hettrich, MD, MPH, and her colleagues in the Multicenter Orthopaedic Outcomes Network (MOON) shoulder group studied 338 patients who underwent surgical intervention for anterior shoulder instability at one of 16 institutions. Metrics evaluated included demographic data, patient‐oriented outcome questionnaires, initial physical exam, treatment, surgical findings and surgical techniques used. Range of motion (ROM) and strength measurements of the affected shoulder were compared with preoperative values at 6-month follow-up. Return to ‐10° ROM and full strength at the 6-month physical exam was considered a return to baseline levels.

Of the 278 patients who had complete preoperative and postoperative ROM and strength data available, 138 (50%) returned to baseline while 133 (50%) did not. Age, Beighton score, Western Ontario Shoulder Instability (WOSI) score, SF-36 general health scores and duration of symptoms were identified by univariate analysis as significant factors for anterior shoulder instability. Of these, a multivariate model showed significant differences in age, SF-36 general health scores and Beighton score.

“This paper has implications for return to sport in younger patients. Patients with more dislocations and patients with laxity may not be ready to return [to sport] in 6 months,” Hettrich said in her presentation. “This would be useful to guide patient expectations preoperatively.” – by Christian Ingram

Reference:

Hettrich CM. Paper #104. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 7-10, 2016; Colorado Springs, Colo.

Disclosure: Hettrich reports she receives research support from Tornier.