Abstract
Purpose: 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. Methods: A consensus process on the treatment using 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. Results: 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 reinjury. 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, premorbid 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. Conclusion: 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 the 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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 234-242.e6 |
| Journal | Arthroscopy - Journal of Arthroscopic and Related Surgery |
| Volume | 38 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2022 |
Keywords
- anterior shoulder instability
- dislocation
- follow-up
- rehabilitation
- return to play
- revision surgery
- shoulder
ASJC Scopus subject areas
- Orthopedics and Sports Medicine
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Anterior Shoulder Instability Part III—Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up—An International Consensus Statement. / The Anterior Shoulder Instability International Consensus Group.
In: Arthroscopy - Journal of Arthroscopic and Related Surgery, Vol. 38, No. 2, 02.2022, p. 234-242.e6.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - Anterior Shoulder Instability Part III—Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up—An International Consensus Statement
AU - The Anterior Shoulder Instability International Consensus Group
AU - Matache, Bogdan A.
AU - Hurley, Eoghan T.
AU - Wong, Ivan
AU - Itoi, Eiji
AU - Strauss, Eric J.
AU - Delaney, Ruth A.
AU - Neyton, Lionel
AU - Athwal, George S.
AU - Pauzenberger, Leo
AU - Mullett, Hannan
AU - Jazrawi, Laith M.
AU - Alaia, Michael J.
AU - Arciero, Robert A.
AU - Bedi, Asheesh
AU - Brophy, Robert H.
AU - Calvo, Emilio
AU - Campbell, Kirk A.
AU - Carter, Cordelia W.
AU - Cassidy, J. Tristan
AU - Ciccotti, Michael G.
AU - Cole, Brian J.
AU - Collin, Philippe
AU - Cordasco, Frank A.
AU - Edwards, Sara E.
AU - Erickson, Brandon J.
AU - Favard, Luc
AU - Frank, Rachel M.
AU - Funk, Lennard
AU - Garrigues, Grant E.
AU - Di Giacomo, Giovanni
AU - Gonzalez-Lomas, Guillem
AU - Heuberer, Philipp R.
AU - Imhoff, Andreas B.
AU - Kelly, John D.
AU - Khan, Moin
AU - Krych, Aaron J.
AU - Kuhn, John E.
AU - Kwon, Young M.
AU - Lädermann, Alexandre
AU - Levine, William N.
AU - Fat, Darren Lim
AU - Mazzocca, Augustus D.
AU - MacDonald, Peter B.
AU - McCarty, Eric C.
AU - Meislin, Robert J.
AU - Millett, Peter J.
AU - Molony, Diarmuid C.
AU - Moran, Cathal J.
AU - Moroder, Philipp
AU - Moya, Daniel
N1 - Funding Information: The authors report the following potential conflicts of interest or sources of funding: I.W. reports grants from Aesculap, Arthrex, and Linvatec and personal fees from Smith & Nephew, outside the submitted work. L.N. reports grants from Tornier and personal fees from Arthrex and Tornier, outside the submitted work. G.A. reports personal fees from ConMed and Exactech, and other from Wright Medical, outside the submitted work. H.M. reports personal fees from ConMed and DJO, outside the submitted work. L.J. reports grants from Arthrex, Mitek, and Smith & Nephew, outside the submitted work. E.S. reports grants from Arthrex, Cartiheal, Fidia, and Organogenesis; personal fess from Arthrex, Fidia, Flexion Therapeutics, JRF, Organogenesis, Smith & Nephew, and Subchondral Solutions; and other from Better PT, outside the submitted work. M.A. reports grants from Concours, personal fees from Mitek, outside the submitted work. R.A.A. reports grants from Arthrex and DJO, personal fees from Smith & Nephew, and other from Biorez, outside the submitted work. A.B. reports personal fees and other from Arthrex, outside the submitted work. E.C. reports grants and personal fees from Depuy and Smith & Nephew and personal fees from Stryker and Wright Medical, outside the submitted work. K.C. reports grants and personal fees from Mitek and Samumed, and personal fees from Stryker, outside the submitted work. B.C. reports grants from Aesculap, Arthrex, and Regentis, personal fees from Arthrex, Regentis, and Samumed, and other from Arthrex, Athletico, Bandgrip, JRF, Ossio, Regentis, and Smith & Nephew, outside the submitted work. P.C. reports personal fees and other from Arthrex and other from Wright, outside the submitted work. F.C. reports personal fees and other from Arthrex, outside the submitted work. B.E. reports grants from Arthrex, DePuy, Linvatec, Smith & Nephew, and Stryker, and personal fees from Arthrex, outside the submitted work. L.F. reports personal fees from Tornier and Wright and other from Wright, outside the submitted work. R.F. reports grants from Arthrex and Smith & Nephew and personal fees from Allosource, Arthrex, JRF, and Ossur, outside the submitted work. L.F. reports grants from Smith & Nephew and personal fees from Arthrex and Smith & Nephew, outside the submitted work. G.G. reports personal fees from Additive Orthopaedics, DJO, Tornier, and Mitek and other from Arthrex, CultivateMD, DJO, Genesys, Patient IQ, ROM 3, SouthTech, and Tornier outside the submitted work. G.D. reports personal fees from Wright, outside the submitted work. P.H. reports personal fees from Arthrex, outside the submitted work. A.I. reports grants from Arthrex, personal fees from Arthrosurface, and other from Arthrex and Arthrosurface, outside the submitted work. J.K. reports personal fees from Flexion, outside the submitted work. A.K. reports grants from Aesculap, Arthrex, Arthritis Foundation, Ceterix, and Histogenics; personal fees from Arthrex, JRF, and Vericel; and other from Arthrex, outside the submitted work. M.K. reports grants from Aesculap, Arthritis Foundation, Ceterix, and Histogenics; and personal fees and other from JRF, Vericel, and Arthrex, outside the submitted work. Y.K. reports personal fees from DJO, outside the submitted work. W.L. reports nonfinancial support from Zimmer, outside the submitted work. A.M. reports grants and personal fees from Arthrex, outside the submitted work. P.M. reports grants from Arthrex, ConMed, Ossur, and Zimmer, outside the submitted work. E.M. reports grants from Arthrex, Biomet, Breg, DJO, Mitek, Ossur, and Smith & Nephew and other from Zimmer, outside the submitted work. R.M. reports grants from Arthrex, ConMed, Mitek, and Stryker, outside the submitted work. P.M reports grants from Arthrex, Ossur, Siemens, and Smith & Nephew; personal fees from Arthrex; and other from MedBridge, Arthrex, and VuMedi, outside the submitted work. P.M. reports grants from Arthrex, personal fees from Arthrex and Mitek; and other from Arthrex and NCS Lab, outside the submitted work. M.S. reports grants from Arthrex, ConMed, Linvatec, and Wright; personal fees from Arthrex, ConMed, DJO, Exactech, and Wright; and other from Arthrex and Wright, outside the submitted work. N.V. reports grants from Arthrex, Breg, Ossur, Smith & Nephew, and Wright; personal fees from Mininvasive and Orthospace; and other from Cymedica, Omeros, and Smith & Nephew, outside the submitted work. M.V. reports personal fees from Acumed and Exactech, outside the submitted work. G.W. reports personal fees from Wright, outside the submitted work. R.W. reports other from Orthonet, outside the submitted work. B.W. reports grants from Arthrex; personal fees from FH Ortho and Vericel; nonfinancial support from Kaliber AI and Sparta Science; and other from Sparta Science and Vivorte, outside the submitted work. J.Z. reports personal fees from MTF and other from Apos Therapy, Exactech, and Hip Innovation Technology, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material . Funding Information: The Anterior Shoulder Instability International Consensus Group includes Michael J. Alaia, Robert A. Arciero, Asheesh Bedi, Robert H. Brophy, Emilio Calvo, Kirk A. Campbell, Cordelia W. Carter, J Tristan Cassidy, Michael G. Ciccotti, Brian J. Cole, Philippe Collin, Frank A. Cordasco, Sara E. Edwards, Brandon J. Erickson, Luc Favard, Rachel M. Frank, Lennard Funk, Grant E. Garrigues, Giovanni Di Giacomo, Guillem Gonzalez-Lomas, Philipp R. Heuberer, Andreas B. Imhoff, John D. Kelly, Moin Khan, Aaron J. Krych, John E Kuhn, Young M. Kwon, Alexandre L?dermann, William N. Levine, Darren LimFat, Augustus D. Mazzocca, Peter B. MacDonald, Eric C. McCarty, Robert J. Meislin, Peter J. Millett, Diarmuid C. Molony, Cathal J. Moran, Philipp Moroder, Daniel Moya, Kieran O'Shea, Brett D. Owens, Matthew T. Provencher, Yong Girl Rhee, Scott A. Rodeo, Andrew S. Rokito, Claudio Rosso, Markus Scheibel, Nikhil N. Verma, Mandeep S. Virk, Gilles Walch, Russell F. Warren, Brian R. Waterman, Daniel B. Whelan, Joseph D. Zuckerman. The authors report the following potential conflicts of interest or sources of funding: I.W. reports grants from Aesculap, Arthrex, and Linvatec and personal fees from Smith & Nephew, outside the submitted work. L.N. reports grants from Tornier and personal fees from Arthrex and Tornier, outside the submitted work. G.A. reports personal fees from ConMed and Exactech, and other from Wright Medical, outside the submitted work. H.M. reports personal fees from ConMed and DJO, outside the submitted work. L.J. reports grants from Arthrex, Mitek, and Smith & Nephew, outside the submitted work. E.S. reports grants from Arthrex, Cartiheal, Fidia, and Organogenesis; personal fess from Arthrex, Fidia, Flexion Therapeutics, JRF, Organogenesis, Smith & Nephew, and Subchondral Solutions; and other from Better PT, outside the submitted work. M.A. reports grants from Concours, personal fees from Mitek, outside the submitted work. R.A.A. reports grants from Arthrex and DJO, personal fees from Smith & Nephew, and other from Biorez, outside the submitted work. A.B. reports personal fees and other from Arthrex, outside the submitted work. E.C. reports grants and personal fees from Depuy and Smith & Nephew and personal fees from Stryker and Wright Medical, outside the submitted work. K.C. reports grants and personal fees from Mitek and Samumed, and personal fees from Stryker, outside the submitted work. B.C. reports grants from Aesculap, Arthrex, and Regentis, personal fees from Arthrex, Regentis, and Samumed, and other from Arthrex, Athletico, Bandgrip, JRF, Ossio, Regentis, and Smith & Nephew, outside the submitted work. P.C. reports personal fees and other from Arthrex and other from Wright, outside the submitted work. F.C. reports personal fees and other from Arthrex, outside the submitted work. B.E. reports grants from Arthrex, DePuy, Linvatec, Smith & Nephew, and Stryker, and personal fees from Arthrex, outside the submitted work. L.F. reports personal fees from Tornier and Wright and other from Wright, outside the submitted work. R.F. reports grants from Arthrex and Smith & Nephew and personal fees from Allosource, Arthrex, JRF, and Ossur, outside the submitted work. L.F. reports grants from Smith & Nephew and personal fees from Arthrex and Smith & Nephew, outside the submitted work. G.G. reports personal fees from Additive Orthopaedics, DJO, Tornier, and Mitek and other from Arthrex, CultivateMD, DJO, Genesys, Patient IQ, ROM 3, SouthTech, and Tornier outside the submitted work. G.D. reports personal fees from Wright, outside the submitted work. P.H. reports personal fees from Arthrex, outside the submitted work. A.I. reports grants from Arthrex, personal fees from Arthrosurface, and other from Arthrex and Arthrosurface, outside the submitted work. J.K. reports personal fees from Flexion, outside the submitted work. A.K. reports grants from Aesculap, Arthrex, Arthritis Foundation, Ceterix, and Histogenics; personal fees from Arthrex, JRF, and Vericel; and other from Arthrex, outside the submitted work. M.K. reports grants from Aesculap, Arthritis Foundation, Ceterix, and Histogenics; and personal fees and other from JRF, Vericel, and Arthrex, outside the submitted work. Y.K. reports personal fees from DJO, outside the submitted work. W.L. reports nonfinancial support from Zimmer, outside the submitted work. A.M. reports grants and personal fees from Arthrex, outside the submitted work. P.M. reports grants from Arthrex, ConMed, Ossur, and Zimmer, outside the submitted work. E.M. reports grants from Arthrex, Biomet, Breg, DJO, Mitek, Ossur, and Smith & Nephew and other from Zimmer, outside the submitted work. R.M. reports grants from Arthrex, ConMed, Mitek, and Stryker, outside the submitted work. P.M reports grants from Arthrex, Ossur, Siemens, and Smith & Nephew; personal fees from Arthrex; and other from MedBridge, Arthrex, and VuMedi, outside the submitted work. P.M. reports grants from Arthrex, personal fees from Arthrex and Mitek; and other from Arthrex and NCS Lab, outside the submitted work. M.S. reports grants from Arthrex, ConMed, Linvatec, and Wright; personal fees from Arthrex, ConMed, DJO, Exactech, and Wright; and other from Arthrex and Wright, outside the submitted work. N.V. reports grants from Arthrex, Breg, Ossur, Smith & Nephew, and Wright; personal fees from Mininvasive and Orthospace; and other from Cymedica, Omeros, and Smith & Nephew, outside the submitted work. M.V. reports personal fees from Acumed and Exactech, outside the submitted work. G.W. reports personal fees from Wright, outside the submitted work. R.W. reports other from Orthonet, outside the submitted work. B.W. reports grants from Arthrex; personal fees from FH Ortho and Vericel; nonfinancial support from Kaliber AI and Sparta Science; and other from Sparta Science and Vivorte, outside the submitted work. J.Z. reports personal fees from MTF and other from Apos Therapy, Exactech, and Hip Innovation Technology, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material. Publisher Copyright: © 2021 Arthroscopy Association of North America
PY - 2022/2
Y1 - 2022/2
N2 - Purpose: 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. Methods: A consensus process on the treatment using 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. Results: 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 reinjury. 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, premorbid 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. Conclusion: 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 the 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.
AB - Purpose: 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. Methods: A consensus process on the treatment using 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. Results: 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 reinjury. 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, premorbid 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. Conclusion: 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 the 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.
KW - anterior shoulder instability
KW - dislocation
KW - follow-up
KW - rehabilitation
KW - return to play
KW - revision surgery
KW - shoulder
UR - http://www.scopus.com/inward/record.url?scp=85112494291&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85112494291&partnerID=8YFLogxK
U2 - 10.1016/j.arthro.2021.07.019
DO - 10.1016/j.arthro.2021.07.019
M3 - Article
C2 - 34332051
AN - SCOPUS:85112494291
SN - 0749-8063
VL - 38
SP - 234-242.e6
JO - Arthroscopy - Journal of Arthroscopic and Related Surgery
JF - Arthroscopy - Journal of Arthroscopic and Related Surgery
IS - 2
ER -