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Patient-reported outcomes differed between men, women with glenohumeral instability
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Results showed initial presentation, pathology and baseline patient-reported outcome scores differed between men and women with glenohumeral instability.
Justin A. Magnuson, BA, Carolyn M. Hettrich , MD, MPH, and colleagues analyzed prospective baseline data for sex-related differences among 1,010 patients (81.3% were men) with glenohumeral instability in the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort using demographic characteristics, patient-reported outcomes, radiographic findings, intraoperative findings and surgical procedures performed. Researchers used the frequency, etiology, direction, severity classification system to categorize patients.
“A higher percentage of male patients experienced traumatic injuries and injury at sport, while hypermobility was identified in a higher percentage of female patients,” Magnuson told Healio.com/Orthopedics.
Results also showed significantly higher activity scores among men and significantly lower preoperative American Shoulder and Elbow Surgeons, Western Ontario Shoulder Instability Index, 36-Item health survey and single assessment numeric evaluation scores among women. Men and women had no significant differences in the number of dislocations. Researchers noted greater rates of labral pathology and bone loss intraoperatively in men and higher rates of capsular laxity among women, which resulted in more Latarjet procedures and more soft-tissue procedures for men and women, respectively.
“Similar to studies in the ACL and rotator cuff tear literature, females had lower baseline patient-reported outcome scores,” Magnuson said. “Future studies will evaluate whether these findings result in significant differences in outcomes.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Christopher L. Camp, MD
As our understanding of the numerous factors that influence shoulder instability continues to grow, each of these variables must be taken into account when developing individualized treatment plans (surgical and nonoperative) for our patients. Some of the most critical factors to consider include injury mechanism, location of labral injury, capsular status, glenoid bone loss, Hill-Sachs defects, patient age, sporting activity and number of prior instability events to name a few. Based on this work from the MOON shoulder instability group, sex is one more factor that should be included in this ever-growing list. In this study of more than 1,000 patients, female patients had similar numbers of instability events, fewer traumatic dislocations, increased capsular laxity, increased generalized ligamentous laxity, decreased bone loss and lower preoperative functional scores. Accordingly, they were more likely to undergo capsular plication and rarely required bony procedures, such as Latarjet. While this is informative data that will assist in the evaluation of these patients, the next step needed is a better understanding of how these differences in preoperative characteristics and surgical procedures influence outcomes.
Assistant professor of orthopedics
Rochester, Minnesota
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