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Non-operative treatment recommended for shoulder instability in young athletes

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Young athletes with shoulder instability can be treated effectively with non-operative methods, according to a new study.

A new tool based on various risk factors can help identify higher-risk patients who may require other forms of treatment, the researchers said.

The findings were presented at the American Orthopaedic Society for Sports Medicine’s recent Specialty Day in New Orleans.

In a retrospective study, researchers examined data on 57 adolescent athletes who were first-time presenters for anterior shoulder instability. They wanted to evaluate patients managed non-operatively for shoulder instability, and to identify factors that led to failure (defined as an inability to return to sport with no subsequent missed time due to shoulder issues).

Factors that were predictive of a higher risk of failure were incorporated into the 10-point Non-operative Instability Severity Index. This score was then retrospectively applied with regression analysis as well as a chi-square analysis to determine the overall score that predicted failure of non-operative management.

The biggest factors associated with failure were age greater than 15, the presence of bone loss, type of instability (subluxation or dislocation), type of sport (collision vs. noncollision), female gender, and arm dominance. These were assigned points based on individual risk.

“Our study showed that of 57 patients who were initially treated non-operatively for anterior shoulder instability, 79% achieved a full return to sport and completed the following season without missing any practice or playing time,” said lead author Dr John M. Tokish, from the Mayo Clinic Arizona. “We also identified certain risk factors, like bone loss, that may make this approach ineffective for certain individuals.”

The results revealed that patients with an overall score of less than 7 returned at a 97% rate, while those who scored greater than 7 had a 59% success rate. Those who were not successful either did not return to their previous sport, or sustained an injury leading to time lost. Of the high-risk patients, those with bipolar bone loss had a failure rate of 67%.

“Deciding how to treat young athletes with shoulder instability can be challenging and controversial, but this research shows doing so without surgery is often successful,” Dr Tokish said.

To guide decision-making, clinical tools like the Non-operative Instability Severity Index can help to determine who is unlikely to benefit from a non-operative treatment approach.

The researchers recommend future studies look at larger patient groups over a longer period to build on this data.

https://www.sportsmed.org/aossmimis/Members/About/Press_Releases/SD2018-ShoulderInstability.aspx

https://www.sportsmed.org/aossmimis/Members/Downloads/MeetingResources/SD2018/Abstract2.pdf