Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleNonoperative Management of Posterior Shoulder Instability: An Assessment of Survival and Predictors for Conversion to Surgery at 1 to 10 Years After Diagnosis
Section snippets
Methods
This population-based study was conducted in Olmsted County, Minnesota (2010 U.S. Census population: 144,260). Patients were identified through the Rochester Epidemiology Project, a medical records linkage system that provides access to complete medical records for all county residents from 1996 to the present.13 The methodology and generalizability of this epidemiological tool have previously been reported in detail.14, 15 A search for diagnostic codes related to PSI yielded 2,091 potential
Results
After review of all records, there were 143 patients with new-onset PSI between January 1, 1994, and December 31, 2015. A total of 64/143 (45%) patients elected to undergo early surgical intervention (<1 year). The remaining 79/143 (55%) patients were initially treated nonoperatively (minimum 1 year). There was no difference in patient demographics between those treated surgically in the first year and those who elected nonsurgical management (Table 1). The 79 patients initially treated
Discussion
Most patients (100/143, 70%) diagnosed with PSI ultimately underwent surgery. Our data demonstrate that although 55% (79/143) of patients elected nonoperative management for a minimum of 1 year, nearly half of these patients (36/79; 46%) converted to surgery between 1 and 10 years after a diagnosis of PSI. Patients who underwent surgery at any time point were at significantly increased risk for radiographic progression of osteoarthritis (P = .02, HR = 4.0) at a minimum 5 years of follow-up.
The
Conclusions
Nonoperative management was performed for at least 1 year in over half of patients diagnosed with PSI. Long-term follow-up demonstrates that 46% of these patients converted to surgery between 1 and 10 years after initial diagnosis. Ultimately, 70% of patients diagnosed with PSI required surgical intervention during the study period. Patients who underwent surgery at any time point were at an increased risk of radiographic progression of arthritis at a minimum of 5 years of follow-up.
References (23)
- et al.
Epidemiology of glenohumeral dislocation and subsequent instability in an urban population
J Shoulder Elbow Surg
(2018) - et al.
Posterior shoulder instability: Prospective non-randomised comparison of operative and non-operative treatment in 51 patients
Orthop Traumatol Surg Res
(2017) - et al.
History of the Rochester Epidemiology Project: Half a century of medical records linkage in a US population
Mayo Clin Proc
(2012) - et al.
Generalizability of epidemiological findings and public health decisions: An illustration from the Rochester Epidemiology Project
Mayo Clin Proc
(2012) - et al.
Obesity and surgical site infections risk in orthopedics: A meta-analysis
Int J Surg
(2013) - et al.
Capsulolabral augmentation for the the management of posteroinferior instability of the shoulder
J Bone Joint Surg Am
(2000) - et al.
Recurrent posterior dislocation of the shoulder
J Bone Joint Surg Am
(1972) Posterior dislocation of the shoulder
J Bone Joint Surg Am
(1952)- et al.
Posterior glenohumeral instability: Evidence-based treatment
J Am Acad Orthop Surg
(2017) - et al.
Recurrent posterior shoulder instability
J Bone Joint Surg Am
(2005)
Recurrent posterior instability (subluxation) of the shoulder
J Bone Joint Surg Am
Cited by (12)
Arthroscopic “Bone Block Cerclage” Technique for Posterior Shoulder Instability
2020, Arthroscopy TechniquesCitation Excerpt :The use of arthroscopic bone block techniques is being adopted more widely nowadays because of their potential benefits, the minimally invasive nature of arthroscopy procedures. and the association between graft osteolysis and glenohumeral osteoarthritis and metal implants.31-33 Moreover, although technically demanding, this technique has been shown to be reliable in restoring glenohumeral contact pressure and having very good clinical results.34,35
Editorial Commentary: Nonoperative Treatments Seem Unreliable in Posterior Shoulder Instability, But Let's Take a Closer Look
2019, Arthroscopy - Journal of Arthroscopic and Related SurgeryPosterior Glenoid Bone Loss and Instability: An Evidence-based Approach to Diagnosis and Management
2023, Journal of the American Academy of Orthopaedic SurgeonsMinimum 10-Year Clinical Outcomes After Arthroscopic Capsulolabral Repair for Isolated Posterior Shoulder Instability
2023, American Journal of Sports Medicine
See commentary on page 1971
The authors report the following potential conflicts of interest or sources of funding: D.L.D. is an editorial or governing board member of the AJSM Medical Publishing Board of Trustees, a board or committee member of the American Orthopaedic Society for Sports Medicine, a board or committee member of the NBA/GE Strategic Advisory Board, and receives research support from Arthrex, and D.L.D.’s spouse owns stock or stock options in and receives IP royalties from Tenex Health and Sonex Health. A.J.K. is a consultant for Arthrex, JRF Ortho, Vericel, Ceterix, and Histogenics and a board member of ISAKOS. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.