Several factors defined as optimal outcomes after anterior shoulder instability surgery
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Key takeaways:
- Optimal outcomes for anterior shoulder instability surgery included reduced pain, instability, osteoarthritis, revision and restricted motion.
- Overall, 41% of patients achieved a perfect outcome.
WASHINGTON — Results showed the optimal observed outcome after anterior shoulder instability surgery included minimal postoperative pain, absence of recurrent instability and osteoarthritis, low revision rates and increased range of motion.
“I think this can be immensely helpful when we're trying to counsel our patients and set appropriate expectations for our patients, our physical therapists and ourselves,” Christopher L. Camp, MD, said in his presentation at the American Orthopaedic Society for Sports Medicine Annual Meeting.
In a retrospective cohort study, Camp and colleagues utilized unsupervised machine-learning clustering algorithms to determine and identify predictors for the optimal observed outcome for patients younger than 40 years undergoing surgery for anterior shoulder instability.
“Our primary outcomes were to identify subgroups that had a composite achievement of each of the following outcomes: full motion within 5° of normal on the contralateral side, no recurrent instability, no revision surgery, no pain, full return to sports, no OA and no complications,” Camp said. “If they were able to achieve all of those, they were deemed to have a perfect outcome.”
Among 228 patients, Camp said 64% achieved the optimal observed outcome, characterized by significantly lower rates of recurrent postoperative pain, recurrent instability, revision surgery, progression to OA and mildly restricted motion. He added 41% of patients achieved a perfect outcome. Predictors of optimal observed outcomes included younger age at the time of initial injury, earlier presentation after initial injury, earlier surgery and fewer instability events prior to surgery, according to Camp.
Although patients in the optimal outcome group had a better performance compared with patients in the suboptimal group, Camp said 22% and 12% of patients in the optimal outcome group experienced recurrent pain and instability, respectively.
“This is not a perfect outcome, but there were high achievers that patients tended to cluster around,” Camp said. “The optimal outcome group did outperform the suboptimal outcome group in all of those area, but they were not perfect.”
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Camp CL, et al. Paper 43. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 12-16, 2023; Washington, D.C.
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