Posterior Shoulder Instability in Throwing Athletes: A Case-Matched Comparison of Throwers and Non-Throwers

Abstract

Purpose: To evaluate the results of arthroscopic capsulolabral repair for the treatment of posterior shoulder instability in a throwing athlete cohort when compared with non-throwers.

Methods: Forty-eight overhead-throwing athletes undergoing arthroscopic posterior capsulolabral reconstruction were case matched with 48 non-throwing athletes. These cohorts were followed as they underwent posterior capsulolabral reconstruction by measuring shoulder pain, function, return to sport, and operative failures. Operative details such as intra-articular pathology and repair construct were also recorded.

Results: At a mean follow-up of 37 months (range, 12 to 97 months) postoperatively, no statistical differences were noted between throwers and non-throwers regarding American Shoulder and Elbow Surgeons scores, stability, strength, or range of motion. Sixty percent of throwing athletes were able to return to their preinjury level of competitive throwing. Throwers with a discrete labral tear intraoperatively had a 10-fold increased likelihood of returning to sport (odds ratio, 9.6; P = .012). Similarly, throwers who had suture anchor constructs showed a 10-fold increased likelihood of returning to play compared with anchor-less repairs (odds ratio, 9.6; P = .012). Non-throwers showed no variability by labral findings or fixation techniques. Pitchers had equivocal outcome scores when compared with other throwers but had poorer return-to-play rates (50% v 60% full return).

Conclusions: Arthroscopic capsulolabral plication for unidirectional posterior shoulder instability is an effective treatment for overhead-throwing athletes. Intraoperatively, achieving an adequate capsular plication and stabilizing the repair with suture anchors will give this athletic population the best odds of returning to competitive sports.

Level of evidence: Level III, retrospective comparative study.