The role of arthroscopic capsulo-labral repair in unidirectional post-traumatic shoulder instability in adolescent athletes participating in overhead or contact sports.

ABSTRACT

PURPOSE: this study was performed to identify the role of arthroscopic capsulo-labral repair (ACR) in unidirectional post-traumatic shoulder instability in adolescent athletes participating in overhead or contact sports. METHODS: sixty-five adolescent patients (aged 13 to 18 years) with post-traumatic shoulder instability submitted to arthroscopic surgery were selected from our database. The mean follow-up duration was 63 months. Shoulder range of motion and functional outcomes were evaluated preoperatively and postoperatively using the Single Assessment Numeric Evaluation (SANE), Rowe, and American Shoulder and Elbow Surgeons (ASES) scores. In addition, details in the database on the type of sport practiced, time until surgery, and number of dislocations were analyzed to look for possible correlations with the recurrence rate. RESULTS: at the final follow-up, the mean SANE score was 87.23% (range 30% to 100%) (preoperative mean score 46.15% [range, 20% to 50%]); the mean Rowe score was 85 (range 30 to 100) (preoperative mean score 35.9 [range 30 to 50]); and the mean ASES score was 84.12 (range 30 to 100) (preoperative mean score 36.92 [range 30 to 48]). Mean forward flexion and external rotation with the arm at 90° abduction did not show changes compared with preoperative values; 81.5% of the patients returned to their pre-injury level of sports activities, and the failure rate was 21.5%. The recurrence rate was not related to the postoperative scores (p = 0.556 for SANE, p = 0.753 for Rowe, and p = 0.478 for ASES), number of preoperative episodes of instability (p = 0.59), or time that elapsed between the first instability episode and the surgery (p = 0.43). A statistically significant association (p = 0.0021) was found between recurrence and the type of sport practiced. CONCLUSIONS: ACR is a reasonable surgical option in an adolescent population participating in sports. It has a role in restoring shoulder stability with very low morbidity; however, the failure rate is higher than in the adult population and both the young patients and their relatives must be properly informed about the expected outcome of the procedure. LEVEL OF EVIDENCE level IV, therapeutic case series.