Risk Factors and Outcomes of Revision Arthroscopic Posterior Capsulolabral Reconstruction in
Contact Athletes
Justin W. Arner, MDSachidhanand Jayakumar, BS
Elan Golan, MDDharmesh Vyas, MDJames P Bradley, MD
DISCLOSURES
James Bradley, MDreceives royalties from Arthrex
Introduction
Literature endorses arthroscopic posterior capsulolabral repair in athletes
lContact / collision athleteslOverhead athletes
Arner JW, et al. Arthroscopic Stabilization of Posterior Shoulder Instability Is Successful in American Football Players. Arthroscopy. 2015
McClincy MP et al. Posterior Shoulder Instability in Throwing Athletes: A Case-Matched Comparison of Throwers and Non-Throwers. Arthroscopy, 2015.
Risk Factors for Posterior Instability • Owens B, et al AJSM 2013
• Most sig risk factor for developing posterior instability is increased glenoid retroversion
• 1 deg of inc retroversion is 17% risk of subsequent post shoulder instability
• Mauro C, McClincy M, Bradley JP AJSM 2016• 200 post repairs decreased bony width was predictive of poorer
outcomes not bone version
• Hines A, Tokish J AJSM 2018• Decreased return to full duty if <13.5% bone loss (RR 1.8) (22% of
pts) BUT outcome scores & revision rates were NO different
Hypothesisl Contact athletes who require revision
arthroscopic posterior unidirectional capsulolabral repair will have:l Poorer outcomes and return to play at 2 yr
min f/u
l Risk factors for revision will include:l younger age, decreased glenoid bone width,
and fewer anchors
Methodsl Risk factors evaluated:
l Age, gender, intra-op severity of injury, level of sport
l MRI:l Bone widthl Labral widthl Cartilage versionl Labral versionl Bone version
l Post op outcomes evaluated:l Return to sport
l Any level vs. same levell Worthwhileness of
original surgery
l Revision rate
ResultsRevisions Non-revisions
Total 11 111Age 18.7 17.4Gender
Male 11 102Female 0 9
Mean f/u (yrs) 12.0Level
Professional 0 4College 1 29High school 10 71
Recreational 0 7
Results: Revision Rate
Revision rate for posterior shoulder instability in contact athletes= 5.9%
ResultsNot risk factors for requiring revision surgery:l Age (p = 0.10)l Gender (p = 0.326) l Level of sport (p = 0.381)
l Isolated labral injury (p = 0.349) l Isolated capsular injury (p = 0.683)
MRI Results
Revision Non-revisionBone width* 26.4 29.2Labral width 31.9 31.6Cartilage version 10.4 11.1Labral version 10.6 11.7Bone version 9.9 10.4*Significant difference (p = 0.005)
Return to Play
l Same level: p < 0.001l Revision = 16.7% l Non-revision = 72.1%
l Overall: p < 0.001l Revision = 50% l Non-revision = 93.7%
Conclusionsl Revision rate = 5.9%
l The only significant risk factor for requiring revision surgery in contact athletes was smaller glenoid bone width.
l Return to play was significantly worse in those who required revision surgery.
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