gms | German Medical Science

Objectives: While patients continue to stay active up until older age, there exists no consensus on the optimal treatment of patients aged >40 years, who are affected by shoulder instability. In particular, there remains a paucity of data on the outcomes following isolated shoulder stabilization those patients, which is largely attributable to the incidence of concomitant rotator cuff tears in shoulder dislocations older patients. The purpose of this study is to report clinical outcomes, return to activity, redislocation rate, and rate of conversion to arthroplasty for active patients over age 40 undergoing primary arthroscopic shoulder stabilization.

Methods: Patients over 40 years of age who underwent arthroscopic capsulolabral repair for shoulder instability between 12/2005 and 01/2018 with a minimum of 2-year postoperative follow-up were enrolled in this retrospective, monocentric study. Clinical outcome scores including the 12-Item Short Form Survey (SF-12), American Shoulder and Elbow Surgeons (ASES), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Single Assessment Numeric Evaluation (SANE), and VAS pain were collected. Additionally, it was determined which patients reached the minimal clinically important difference (MCID) and the patient acceptable symptom state (PASS) for the ASES score. Bivariate analysis was utilized to determine if there was any association between baseline demographic and clinical factors with the outcome scores.

Results and conclusion: Of a total of 814 patients assessed for eligibility, a total of 40 patients were included and 33 patients (8 females) were available for follow-up. Average age was 49.4 ± 7.6 years. At an average follow-up of 7.0 ± 3.6 years, all the outcome scores significantly improved compared to baseline. These include ASES (69.9 ± 19 to 95.8 ± 7.6, p<.001), QuickDASH (29.7 ± 17.7 to 3.9 ± 5.4, p<.002); SANE (53.5 ± 29.3 to 91.6 ± 14.3, p<.003), SF-12 (45.6± 8.8 to 55.2 ± 5.7, p<.001) and VAS (2.1 ± 2.1 to 0.3 ± 1, p< .002). MCID was reached by 72.7% of the patients and 81.8% reached the PASS threshold for the ASES score. Postoperative shoulder stability improved substantially and significantly. 95.6% of the patients returned to sport, with 91.0% of the patients able to return to pre-injury level. One patient (3%) underwent revision surgery for osteoarthritis, in the form of comprehensive arthroscopic management procedure. The presence of cartilage defects cartilage defects Outerbridge grade>2 (p=0.020) and posterior labral lesions (p=0.03) at index surgery were significantly associated with inferior outcomes in the ASES score.

Active patients aged 40 years and older undergoing arthroscopic shoulder stabilization experienced favorable functional outcomes at a mean follow-up of 7 years, with low rates of revision surgery or of progression to clinically relevant osteoarthritis. However, the presence of high-grade cartilage lesions and the presence of a posterior labral tear were associated with inferior clinical outcomes.