Bogdan A. Matache, MD CM, FRCSC, Eoghan T. Hurley MB, BCh, MCh, Ivan Wong, Eiji Itoi, Eric J.Strauss, Ruth A. Delaney, Lionel Neyton, George S. Athwal, Leo Pauzenberger, Hannan Mullett, Laith M. Jazrawi, The Anterior Shoulder Instability International Consensus Group
The purpose of this study was to establish consensus statements via a modified Delphi process on revision surgery, rehabilitation and return to play, and clinical follow-up for anterior shoulder instability.
A consensus process on the treatment utilizing a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability.
The primary relative indications for revision surgery include symptomatic apprehension or recurrent instability, additional intra-articular pathologies, and symptomatic hardware failure. In revision cases, the differentiating factors that dictate treatment are the degree of glenohumeral bone-loss and rotator cuff function/integrity. The minimum amount of time before allowing athletes to return to play is unknown, but other factors should be considered, including restoration of strength, range of motion and proprioception, and resolved pain and apprehension, as these are prognostic factors of re-injury. Additionally, psychological factors should be considered in the rehabilitation process. Patients should be clinically followed-up for a minimum of 12-months or until a return to full, pre-morbid function/activities. Finally, the following factors should be included in anterior shoulder instability-specific patient-reported outcome measures: function/limitations impact on activities of daily living, return to sport/activity, instability symptoms, confidence in shoulder, and satisfaction.
Overall, 92% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were indications and factors affecting decisions for revision surgery, as well as how prior surgeries impact procedure choice. Furthermore, there was unanimous consensus on the role of psychological factors in return to play, considerations for allowing return to play, as well as prognostic factors. Finally, there was a lack of unanimous consensus on recommended timing and methods for clinical follow-up.
Level of Evidence
Level V Expert Opinion
You may request the study: Anterior Shoulder Instability Part III – Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up – An International Consensus Statement
You may also dowload and/or pay for the study HERE