ADVERTISEMENT

In Throwers With Posterior Instability, Rotator Cuff Tears Are Common but Do Not Affect Surgical Outcomes

January 30, 2018 | Surgery
Justin W. Arner, MD ; Michael P. McClincy, MD ; James P. Bradley, MD
Author and Disclosure Information

Authors’ Disclosure Statement: Dr. Bradley reports that he receives royalties from Arthrex. The other authors report no actual or potential conflict of interest in relation to this article.  

Dr. Arner is an Orthopaedic Resident, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Dr. McClincy is a Fellow, Sports Medicine Division, Harvard University, Boston Children’s Hospital, Boston, Massachusetts. Dr. Bradley is a Clinical Professor, University of Pittsburgh Medical Center and Burke and Bradley Orthopedics, Pittsburgh, Pennsylvania.

Address correspondence to: James P. Bradley, MD, Burke and Bradley Orthopedics, 200 Medical Arts Building, Suite 4010, 200 Delafield Rd, Pittsburgh, PA 15215 (tel, 412-784-5770; fax, 412-784-5776; email, bradleyjp@upmc.edu).

Justin W. Arner, MD Michael P. McClincy, MD James P. Bradley, MD . In Throwers With Posterior Instability, Rotator Cuff Tears Are Common but Do Not Affect Surgical Outcomes. Am J Orthop. January 30, 2018

TAKE-HOME POINTS

  • Arthroscopic capsulolabral reconstruction is successful in throwing athletes with concomitant RCTs treated with arthroscopic débridement.
  • A previous study of throwing athletes found poor outcomes after surgery for concomitant SLAP tears and RCTs.
  • Throwing athletes with concomitant posterior shoulder instability and RCTs were no different in patient-reported outcomes or return to play.
  • The high proportion of throwing athletes with partial thickness RCTs in this study (43%) indicates a need for close evaluation of rotator cuff pathology in young throwing athletes.
  • The authors theorize the main pain generator in this population may be posterior instability and that the rotator cuff has less of an influence.

STUDY LIMITATIONS

Limitations of this study include its small number of professional throwing athletes, with the majority being high school athletes. Further, although ASES scores are consistently used in posterior shoulder instability studies, these scores are influenced highly by pain scores, and some argue that other scoring systems may provide more useful information. However, none of the more modern scoring systems have been studied extensively in posterior glenohumeral instability. Further, because the authors used the present scoring systems previously,1-4 they were continued to be used for comparison and consistency. Outcomes such as ROM and strength may carry more weight if measured and documented by clinical examination. Further testing, such as clinical evaluation of the jerk test or the posterior load-and-shift test, and their comparison before and after surgery may provide more objective data.

CONCLUSION

Arthroscopic capsulolabral reconstruction is successful in throwing athletes with RCTs treated with arthroscopic débridement. Unlike a previous study of throwing athletes’ outcomes after surgery for concomitant SLAP tears and RCTs,5 this study of throwing athletes with concomitant posterior shoulder instability and RCTs found no difference in patient-reported outcome measures or return to play. In throwing athletes with posterior instability and RCTs, arthroscopic posterior capsulolabral repair with rotator cuff débridement is successful.

ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT