I'm a new sports medicine surgeon at the Colorado Permanente Medical Group up in Denver, a former University of Pittsburgh sports fellow. And my PI on this project was Dr. Albert Lin. Let's see if this thing works. Perfect. These are Dr. Lin's disclosures, none of which are relevant here. So as a, just by way of introduction, traditional return to sports criteria for posterior shoulder instability has been somewhat arbitrary based on the patient's perceptions and the surgeon's perceptions of strength, range of motion, as well as the relatively arbitrary passage of time. Most of these patients going back to full activity somewhere around five to six months, regardless of objective measures. So as you know, not to, I mean, I guess I'm preaching to the choir here, but as we all know with ACL and now many other pathologies, objective return to sport testing has been shown to be useful in screening out patients who need a little bit more work before being ready to go. Some of our previous work described return to sport testing for anterior shoulder instability. So we wondered whether this return to sport testing could be applicable to a posterior shoulder instability cohort. So we had previously reported similar, the outcomes of a similar study looking at reducing failure rates for anterior shoulder instability for patients undergoing isolated soft tissue arthroscopic Bankart procedures. We demonstrated that there was a four times lower rate of recurrence with completing return to sport testing. However, in the realm of posterior shoulder instability, it's been demonstrated that there is fairly high recurrence rates as far as symptoms go of about 11% reported in AJS SAMBU 2021. So our purpose was to investigate the use of a validated objective return to sport testing protocol for the shoulder following arthroscopic posterior shoulder stabilization. Our hypothesis was this would likely reduce the reoperation and recurrence rate. These were our methods. This was a retrospective review case control study with one year follow-up. Patients were all age under 30. Our case group was a group of 20 consecutive patients undergoing isolated arthroscopic posterior capsular labral repair between 2016 and 2019. We excluded anyone undergoing open surgery or surgery for MDI. They must have fully completed the return to sport testing at six months. We compared these patients to a control group, 42 patients who are matched, who had undergone the same procedures between 2012 and 2015 prior to when we instituted this return to sport testing. Here we defined as recurrent symptoms of instability, recurrence of pain, or any sort of reoperation. And the phased rehab protocol that we see is on the right that we used. Diving into the weeds a little bit here, these were the tests that we looked at. The first was strength testing, looking at isokinetic internal and external rotation, as well as an external rotation endurance test. In terms of functional testing, we used this closed kinetic chain upper extremity test, which is depicted up on the upper right-hand corner of the screen, as well as a unilateral seated shot put test, both of which have been validated in the shoulder. In terms of our results, we found no significant differences between cohorts in terms of age, gender, hand dominance, whether or not there was a concomitant slap repair, the occurrence of hyperlaxity, or the number of anchors used. There was a slight difference with more competitive athletes being represented in our case group compared to our control group. Otherwise, no significant differences. In terms of results, recurrent instability rates in our case group were 5.6% compared to 4.8%, not significantly different. We didn't note any significant differences with regards to pain, recurrent instability, or re-operation. So the main take-home points that we have here is that return to sport testing may be less critical, noting that we didn't see any significant difference within our small cohort, may be less critical in reducing failure rates in patients with posterior shoulder instability who have undergone arthroscopic posterior shoulder stabilization. We have a couple of hypotheses around why this might be happening, or why we observe this. One is that recurrent posterior instability may be either less obvious or more well-tolerated by patients than, say, recurrent anterior instability or ACL graft failure. As well, we had an overall low re-operation rate of just a handful in both, so our study could potentially be underpowered to detect any difference that might exist. We had several limitations. This was a consecutive series with one surgeon. Many potential sources of bias, I realize I'm running low on time. So criteria-based return to sport testing can detect hidden deficits that might not be obvious. We didn't detect any changes in outcomes. However, further studies might be necessary to elucidate any sort of role that this has in posterior shoulder stabilization. Thank you.

sports medicine surgeon

Colorado Permanente Medical Group

objective return to sport testing

posterior shoulder instability

validated testing protocol