AJSM Webinar Series: Posterior Shoulder Instability: Understanding the Dark Side of the Shoulder-Minimum 10-Year Clinical Outcomes After Arthroscopic Capsulolabral Repair for Isolated Posterior Shoulder Instability

Minimum 10-Year Clinical Outcomes After Arthroscopic Capsulolabral Repair for Isolated Posterior Shoulder Instability

Pdf Summary

This study evaluated the long-term clinical outcomes of arthroscopic capsulolabral repair for isolated posterior shoulder instability in 53 patients (55 shoulders) with a mean follow-up of 15.4 years. Posterior shoulder instability, often affecting athletic populations, is associated with pain and dysfunction, and arthroscopic repair is a recognized treatment. While short- and midterm outcomes have been reported, long-term results were previously unknown.<br /><br />Key findings include significant improvements in shoulder function, pain, stability, strength, and range of motion at long-term follow-up compared to preoperative assessments, with largely stable outcomes relative to short-term follow-up at 3 years. According to the American Shoulder and Elbow Surgeons (ASES) score, 77% of shoulders showed good to excellent results long-term. However, only 35% returned to their preinjury sport level, and 60% returned at some level; the majority had discontinued the original sport by 15 years post-op, often due to life transitions rather than shoulder problems.<br /><br />Subgroup analyses revealed that throwing athletes trended toward worse pre- and postoperative sport-specific function and lower return-to-sport rates compared to nonthrowers. Contact and noncontact athletes had similar outcomes and return-to-sport rates. Failure, defined as revision surgery, ASES score below 60, or stability worse than a threshold, occurred in 35% of shoulders; 13% underwent revision surgery, typically after an acute postoperative injury and in patients with a smaller glenoid bone width on MRI, identified as a risk factor for revision. Revision surgery improved outcomes relative to pre-revision failure status but had worse long-term outcomes than nonrevision cases.<br /><br />Despite a notable failure and revision rate, 89% of patients rated surgery as worthwhile. The study acknowledges limitations including loss to follow-up and reliance on subjective outcome measures. Nevertheless, it provides strong evidence supporting arthroscopic capsulolabral repair as a durable treatment that improves long-term shoulder function and facilitates return to sports in most patients with posterior shoulder instability, with the caveat that throwing athletes may have less optimal outcomes.

Keywords

arthroscopic capsulolabral repair

posterior shoulder instability

long-term clinical outcomes

shoulder function improvement

return to sport

throwing athletes

revision surgery

glenoid bone width

American Shoulder and Elbow Surgeons (ASES) score

shoulder stability