Posterior shoulder instability in the athletic population: Variations in assessment, clinical outcomes, and return to sport

Table 1 Arthroscopic clinical outcomes of athletes - Posterior shoulder instability n (%)

Ref.	Evidence level	Primary procedure	No. total shoulders	No. athletic shoulders	Mean age,yr (range)Female/Male	Mean follow-up,mo (range)	Recurrence rate	Subjective stability(Stable or E/G)	Patient satisfaction	Return to sport (any level)	Return to sport (pre-injury level)
Bradley et al[18]	II	CLR	200	Overall:	Overall:	Overall:	Overall:	Overall:	Overall:	Overall:	Overall:
				200	24 (15-65)	37 (12-115)	12 (6) failures via ASES	182 (91)	187 (94)	180 (90)	127 (64)
					42 F/158 M		14 (7) failures via stability scale
							7 (4) failures via both ASES and stability scale
				Contact sport:	Contact sports:	Contact sports:	Contact athlete:	Contact athlete:	Contact athlete:	Contact athlete:	Contact athlete:
				117	21 (16-28)	35 (12-77)	7 (6) via ASES	110 (94)	111 (95)	106 (91)	81 (69)
				Overhead/Throwers:	NR, F/NR, M		4 (4) via stability scale
				60			3 (3) via ASES and stability scale
Schwartz et al[29]	IV	BB	19	Overall:	30 (15-56)	21 ( 13-32)	3 (6)	16 (84)	16 (84)	16 (89)	9 (50)
				18	5 F/13 M		(1 bilateral patient with persistent instability of unknown etiology, contralateral shoulder was revised; 1 patient persistent pain due to prominent graft)
			(1 patient Ehlers Danlos)	Contact sport:
				13
Wanich et al[30]	IV	10 CLR	12	12 Baseball	21 (16-33)	34 (18-64)	1 (8)	NR	NR	11 (92)	11 (92)
		2 DB only		“batter's shoulder”	0 F/12 M
Lenart et al[31]	IV	CLR	22	19	NR	NR	2 (9)	NR	NR	19 (100)	19 (100)
Bahk et al[15]	IV	CLR	29	28	26 (18.3-43.4)	66 (24-149)	1 (3.4)	28 (97)	28 (97)	22 (85)	17 (68)
					1 F/28 M			≥ 30 yr old, lower instability scores (P = 0.041)
Savoie et al[14]	IV	CLR	92	Overall:	26 (15-59)	28 (12-132)	2 (2)	90 (98)	NR	NR	NR
				81	21 F/69 M
				Throwing sports:
				32
Radkowski et al[19]	II	CLR	107	Overall:	Overall:	Throwing athletes:	11/107 (10)	No difference between 2 groups for postoperative stability		Overall:	Overall:
				107	23 F/84 M	28 (range, NR; SD ± 11.6)		Overall:		96/107 (90)	72/107 (67)
				Throwing sports:	Throwing athletes:	Nonthrowing:		96/107 (90)
				27	21 (range, NR; SD ± 5.5)	28 (range, NR, SD ± 12.5)		Throwers:		Throwers:	Throwers:
				Nonthrowing sports:	7 F/20 M			24/27 (89)		23/27 (85)	15/27 (55)
				80	Nonthrowing athletes:			Nonthrowers:		Nonthrowers:	Nonthrowers:
					24 (range, NR; SD ± 9.1)			72/80 (90)		73/80 (91)	57/80 (71)
					16 F/64 M
Bradley et al[8]	II	CLR	100	Overall:	23 (15-61)	(12-77)	Overall:	Overall: 89 (89)	Overall:	Overall:	Overall:
				100	23 F/77 M		9 (9) failures according to ASES		92 (92)	89 (89)	67 (67)
				Contact sports:			11 (11) failures according to the standardized stability scale
				51			Contact athlete:	Contact athlete:	Contact athlete:	Contact athlete:	Contact athlete:
				Overhead/ Throwers:			3 (6) failures according to ASES	43 (84)	46 (90)	44 (86)	38 (74)
				28			5 (10) according to standardized stability scale
Bottoni et al[32]	IV	CLR	19	17	NR	40 (24-63)	1 (5)	NR	NR	NR	NR
		TC
Bisson[33]	IV	TC	14	Overall:	19 (15-32)	36 (26-53)	(3/14)	11 (79)	14 (100)	14 (100)	6 (43)
				14	Shoulders:		(1 bilateral)
				Contact sports:	4 F/10 M
				7
				Overhead sport:	Patients:
				1 swimmer	4 F/8 M
				Sport NR:
				6
Goubier et al[34]	IV	CLR	13	Overall:	33 (18-47)	34 (11-80)	0 (0)	NR	13 (100)	NR	8 (89)
				11	5 F/8M
				Contact sports:
				1
				Overhead/ Throwers:
				3
Kim et al[35]	IV	CLR	27	Overall:	21 (14-33)	39 (24-85)	1 (4)	26 (96)	NR	26 (96)	NR
				27	2 F/25 M
				Contact sports:
				9
				Overhead /Throwing:
				6/6
Williams et al[36]	IV	CLR	27	Overall:	29 (15-55)	61 (24-140)	2 (7)	25 (93)	25 (96)	25 (93)	NR
				27	0 F/27 M
				Contact sports:
				11
				Overhead/Throwers:
				5
Wolf et al[9]	IV	CLR	14	Overall:	26 (14-54)	33 (24-45)	1 (7)	13 (93)	14 (100)	10 (100)	9 (90)
				10	3 F/11 M		traumatic reinjury
				Contact sports:
				3
				Overhead/Throwers:
				2 (1 baseball pitcher, 1 tennis)
McIntyre et al[13]	IV	CLR	20	Overall:	22 (15-36)	31 (24-44)	5 (25)	17 (85)	NR	NR	12 (86)
				14	4 F/15 M		(2 recurrent dislocations, 3 subluxations)
				Contact sports:
				5 football (2 resulted in dislocations)
				Overhead/ Throwers:
				2 baseball pitchers
Papendick et al[37]	IV	CLR PIGHLR	41	Overall:	23 (15-42)	10 (4-41)	2 (4.8) recurrence	NR	39 (95)	36 (100)	NR
				36	NR, F/NR, M		(both recurrent dislocation)
				Overhead/ Throwers:
				21

AC: Acromioclavicular; ADL: Activities of daily living; ASES: American shoulder and elbow score; BB: Bone block; CI: Capsular imbrication; CLR: Capsulolabral repair; CP: Capsular plication; CR: Capsular repair; CS: Capsular shift; DB: Debridement; E/G: Excellent to good; GHLR: Glenohumeral ligament repair; IGHLR: Inferior glenohumeral ligament repair; LR: Labral repair; MDI: Multidirectional instability; NR: Not reported; PB: Posterior bankart; PHAGLR: Posterior humeral avulsion of the glenohumeral ligament repair; PIGHLR: Posterior inferior glenohumeral ligament repair; PSS: Penn shoulder score; ROM: Range of motion; SAD: Subacromial decompression; SANE: Single assessment numeric evaluation; SF-36: Short form health survey; SST: Simple shoulder test; TC: Thermal capsulorrhaphy; UCLA: University of California Los Angeles shoulder score; VAS: Visual analog scale; WD: Walch-Duplay; WOSI: Western ontario shoulder instability.

Table 2 Open clinical outcomes of athletes - Posterior shoulder instability n (%)

Ref.	Evidence level	Primary procedure	No.total shoulders	No.athletic shoulders	Mean age, yr (range)	Mean follow-up, mo (range)	Recurrence rate	Stability subjective(e/G)	Patient satisfaction(S or E/G)	Return to sport (any level)	Return to sport (preinjury level)
Servien et al[6]	IV	BB	21	19	24.8 (17-40)	72 (24-228)	3 (14)	21 (100)	21 (100)	17 (89)	13 (68)
Misamore et al[38]	IV	Capsulorrhaphy	14	14	19.6 (15-26)	45 (26-90)	1 (7)	13 (93)	NR	13 (93)	12 (86)
Hawkins[39]	IV	BB	10	8	26.4 (20-39)	61 (32-100)	1 (10)	9 (90)	NR	NR	NR
Hurley et al[40]	IV	Reverse Putti-Platt w/o bony procedure	22	22	18.3 (13-30)	60 (24-132)	16 (73)	NR	NR	15 (68)	1 (45)
Surin et al[41]	IV	Rotational Osteotomy of Humerus	11	6	23 (16-30)	80.73 (24-144)	0 (0)	11 (100)	10 (91)	4 (100)	3 (75)
Hawkins et al[42]	IV	Posterior Glenoid Osteotomy/Capsulotendinous Plication/Reverse Putti-Platt	26	26	21 (NR)	86 (24-180)	13 (50)	NR	NR	10 (38)	NR

BB: Bone block; CLR: Capsulolabral repair; NR: Not reported.