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Study: Bracing not effective in returning high school athletes to sport after shoulder instability
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NEW ORLEANS — Bracing was not efficacious as an adjunct method to standard conservative care for shoulder instability in high school athletes, according to results presented here.
“Findings suggest functional bracing is not an effective adjunct to nonoperative management of anterior shoulder instability in returning athletes to sport, at least at a high school level,” Michael J. Kissenberth, MD, said at the American Shoulder and Elbow Surgeons Annual Meeting.
Kissenberth and colleagues performed a statistical analysis of 97 high school athletes with anterior shoulder instability. Of these athletes, 20 were treated with a brace and 77 were not braced. A subanalysis looked at patients who played football and compared patients who had subluxations vs. dislocations.
“Treatment success was defined as completion of the index and subsequent seasons without surgery or additional time loss from shoulder injury,” Kissenberth said. “Athletes were considered returned to sport after undergoing rehab and receiving a clearance from the treating physician.”
Results showed a return-to-sport rate of 87%, and Kissenberth noted no significant differences in return to play between the braced and non-braced groups. Kissenberth also noted no differences in age, height and weight between patients who successfully and those who unsuccessfully returned to sport.
“Most braced athletes played football, 17 of the 20 that were braced,” he said. “Subanalysis between the football players has demonstrated no difference in brace failures and non-brace failure.” – by Casey Tingle
Reference:
Shanley E, et al. Paper #28. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 12-14, 2017; New Orleans.
Disclosure: Kissenberth reports he receives other financial or material support from Arthrex Inc., Arthrocare, Arthrosurface, Breg, DJ Orthopaedics, Greenville Hospital System, Neurotech, Pacira and Smith & Nephew; is a paid consultant for Arthrex Inc.; and is a board or committee member for The Hawkins Foundation.
Perspective
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Joseph A. Abboud, MD
This paper “tackles” the common dilemma of nonoperative management of shoulder instability in competitive collegiate athletes. The question the authors tried to answer is, “to brace or not to brace?” The abstract demonstrated surprising results in that patients treated with nonoperative management and functional bracing had similar outcomes to patients who were not braced. There was no statistical difference in the successful return to play between athletes treated with functional bracing and those who were not (P = .16). Brace-treated athletes failed to return to play 26% of the time, while those treated without a brace failed to return at a rate of 14%.
Given that this study consisted of 111 patients who were treated nonoperatively, of which 23 patients used bracing as an adjunct treatment, this arm of the study is likely underpowered. In conclusion, I applaud the authors for putting forth the first study to evaluate the effectiveness of bracing in returning an athlete to a full, subsequent season without surgery or time loss due to injury to the shoulder. However, a larger prospective randomized study is necessary to adequately answer this question once and for all.
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