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Arthroscopic Capsulolabral Repair for Posterior Shoulder Instability in Throwing Athletes Compared With Nonthrowing Athletes

Christopher A. Radkowski, MD^,*, Anikar Chhabra, MD, MS, Champ L. Baker, III, MD, Samir G. Tejwani, MD and James P. Bradley, MD^||

From Pittsburgh Bone & Joint Surgeons, McKeesport, Pennsylvania, Canyon Orthopaedic Surgeons Ltd, Division of Sports Medicine, Phoenix, Arizona, University of Pittsburgh, Center for Sports Medicine, Pittsburgh, Pennsylvania, and ^|| Burke and Bradley Orthopaedics, Pittsburgh, Pennsylvania

^* Address correspondence to Christopher A. Radkowski, MD, Pittsburgh Bone & Joint Surgeons, 1321 Fifth Avenue, McKeesport, PA 15132 (e-mail: chrisradkowski{at}yahoo.com).

Background: There are limited studies evaluating arthroscopic treatment of unidirectional posterior shoulder instability in overhead-throwing athletes.

Hypothesis: Arthroscopic capsulolabral repair for unidirectional posterior shoulder instability will yield equivalent stability and functional outcomes in the overhead-throwing athlete and nonthrowers.

Study Design: Cohort study; Level of evidence, 2.

Methods: Ninety-eight athletes (107 shoulders) with unidirectional posterior shoulder instability were treated with arthroscopic posterior capsulolabral reconstruction or, rarely, capsular plication alone, as determined by their specific intra-articular lesions. Patients were evaluated prospectively with the American Shoulder and Elbow Surgeons scoring system. Stability, range of motion, strength, pain, and function were assessed preoperatively and postoperatively with standardized subjective scales. Results for 27 dominant shoulders in throwing athletes (25%) were compared with those for 80 shoulders in nonthrowing athletes (75%).

Results: At a mean follow-up of 27 months postoperatively, there were no differences in the American Shoulder and Elbow Surgeons score or scores for stability, range of motion, strength, pain, and function between the throwers and nonthrowers, with both groups showing a significant improvement in all categories (P < .0001). Excellent or good results were achieved in 89% of the throwers and 93% of the nonthrowers. Throwing athletes were less likely to return to their preinjury levels of sport (55%) compared with nonthrowing athletes (71%).

Conclusion: Arthroscopic posterior capsulolabral repair effectively improves stability, range of motion, strength, pain, and function in throwing athletes with unidirectional posterior shoulder instability. Despite similar outcome measures to nonthrowers, throwing athletes are less likely to return to their preinjury levels of sport.

Key Words: shoulder • arthroscopy • posterior instability • throwers • capsulolabral repair