TY - JOUR
T1 - Nonoperative Management of Posterior Shoulder Instability
T2 - An Assessment of Survival and Predictors for Conversion to Surgery at 1 to 10 Years After Diagnosis
AU - Woodmass, Jarret M.
AU - Lee, Julia
AU - Johnson, Nick R.
AU - Wu, Isabella T.
AU - Camp, Christopher L.
AU - Dahm, Diane L.
AU - Krych, Aaron J.
N1 - Funding Information:
The authors report the following potential conflicts of interest or sources of funding: D.L.D. is an editorial or governing board member of the AJSM Medical Publishing Board of Trustees, a board or committee member of the American Orthopaedic Society for Sports Medicine, a board or committee member of the NBA/GE Strategic Advisory Board, and receives research support from Arthrex, and D.L.D.’s spouse owns stock or stock options in and receives IP royalties from Tenex Health and Sonex Health. A.J.K. is a consultant for Arthrex, JRF Ortho, Vericel, Ceterix, and Histogenics and a board member of ISAKOS. Full ICMJE author disclosure forms are available for this article online, as supplementary material.This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors report the following potential conflicts of interest or sources of funding: D.L.D. is an editorial or governing board member of the AJSM Medical Publishing Board of Trustees, a board or committee member of the American Orthopaedic Society for Sports Medicine, a board or committee member of the NBA/GE Strategic Advisory Board, and receives research support from Arthrex, and D.L.D.’s spouse owns stock or stock options in and receives IP royalties from Tenex Health and Sonex Health. A.J.K. is a consultant for Arthrex, JRF Ortho, Vericel, Ceterix, and Histogenics and a board member of ISAKOS. Full ICMJE author disclosure forms are available for this article online, as supplementary material. This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2019 Arthroscopy Association of North America
PY - 2019/7
Y1 - 2019/7
N2 - Purpose: To (1) define the rate of delayed surgery, between 1 and 10 years after injury, in a population-based study of patients with posterior shoulder instability (PSI), (2) evaluate predictive factors associated with delayed repair, and (3) identify differences between the nonoperative and operative groups at long-term follow-up. Methods: A population-based retrospectively reviewed study of all patients with PSI from January 1, 1994, to December 31, 2015, was performed. Inclusion required a clinical diagnosis of PSI combined with supporting imaging. Complete medical records were reviewed for 2,091 potential cases. Kaplan-Meier estimates were used to calculate survival. Landmark survival analysis was performed to identify predictors of conversion to surgery. Results: The study included 143 patients with PSI, 79 of whom were managed nonoperatively for at least 1 year after diagnosis. After the first year, survival free of surgery was 78.3% at 1 year, 63.1% at 5 years, and 51.5% at 10 years. There was a trend toward increased surgery in patients with a body mass index > 35 (P = .10; hazard ratio = 2.32; confidence interval, 0.8-6.8). Nonthrowing athletes (including contact/weight-lifting athletes) showed a trend toward an increased risk for surgery (P = .07). Patients who underwent surgery were significantly more likely to have progression in arthritis (P = .02; hazard ratio = 4.0; confidence interval, 1.2-13.2). Conclusions: Nonoperative management was performed for at least 1 year in over half of patients diagnosed with PSI. Overall, long-term follow-up demonstrates that 46% of these patients converted to surgery between 1 and 10 years after initial diagnosis. Ultimately, 70% of patients diagnosed with PSI go on to surgical intervention. Patients who underwent surgery at any time point were at an increased risk of radiographic progression of arthritis at a minimum of 5 years of follow-up. Level of Evidence: Level III, cohort study.
AB - Purpose: To (1) define the rate of delayed surgery, between 1 and 10 years after injury, in a population-based study of patients with posterior shoulder instability (PSI), (2) evaluate predictive factors associated with delayed repair, and (3) identify differences between the nonoperative and operative groups at long-term follow-up. Methods: A population-based retrospectively reviewed study of all patients with PSI from January 1, 1994, to December 31, 2015, was performed. Inclusion required a clinical diagnosis of PSI combined with supporting imaging. Complete medical records were reviewed for 2,091 potential cases. Kaplan-Meier estimates were used to calculate survival. Landmark survival analysis was performed to identify predictors of conversion to surgery. Results: The study included 143 patients with PSI, 79 of whom were managed nonoperatively for at least 1 year after diagnosis. After the first year, survival free of surgery was 78.3% at 1 year, 63.1% at 5 years, and 51.5% at 10 years. There was a trend toward increased surgery in patients with a body mass index > 35 (P = .10; hazard ratio = 2.32; confidence interval, 0.8-6.8). Nonthrowing athletes (including contact/weight-lifting athletes) showed a trend toward an increased risk for surgery (P = .07). Patients who underwent surgery were significantly more likely to have progression in arthritis (P = .02; hazard ratio = 4.0; confidence interval, 1.2-13.2). Conclusions: Nonoperative management was performed for at least 1 year in over half of patients diagnosed with PSI. Overall, long-term follow-up demonstrates that 46% of these patients converted to surgery between 1 and 10 years after initial diagnosis. Ultimately, 70% of patients diagnosed with PSI go on to surgical intervention. Patients who underwent surgery at any time point were at an increased risk of radiographic progression of arthritis at a minimum of 5 years of follow-up. Level of Evidence: Level III, cohort study.
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U2 - 10.1016/j.arthro.2019.01.056
DO - 10.1016/j.arthro.2019.01.056
M3 - Article
C2 - 31196692
AN - SCOPUS:85066958519
SN - 0749-8063
VL - 35
SP - 1964
EP - 1970
JO - Arthroscopy - Journal of Arthroscopic and Related Surgery
JF - Arthroscopy - Journal of Arthroscopic and Related Surgery
IS - 7
ER -