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 - 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 -