TY - JOUR
T1 - Posterior Shoulder Instability, Part I—Diagnosis, Nonoperative Management, and Labral Repair for Posterior Shoulder Instability—An International Expert Delphi Consensus Statement
AU - The Posterior Shoulder Instability International Consensus Group
AU - Hurley, Eoghan T.
AU - Aman, Zachary S.
AU - Doyle, Tom R.
AU - Levin, Jay M.
AU - Jazrawi, Laith M.
AU - Garrigues, Grant E.
AU - Namdari, Surena
AU - Hsu, Jason E.
AU - Klifto, Christopher S.
AU - Anakwenze, Oke
AU - Dickens, Jonathan F.
AU - Athwal, George S.
AU - Bishop, Julie Y.
AU - Boache-Adjei, Yaw
AU - Bradley, Kendall E.
AU - Brophy, Robert H.
AU - Calvo, Emilio
AU - Camp, Christopher L.
AU - Cassidy, Tristan
AU - Chalmers, Peter N.
AU - Cordasco, Frank A.
AU - Danilkowicz, Richard M.
AU - Dekker, Travis A.
AU - Delaney, Ruth A.
AU - Denard, Patrick J.
AU - Duralde, Xavier A.
AU - Erickson, Brandon J.
AU - Ernstbrunner, Lukas
AU - Frangiamore, Salvatore J.
AU - Freehill, Michael T.
AU - Goltz, Daniel E.
AU - Griffith, Timothy B.
AU - Heuberer, Philipp R.
AU - Hoy, Greg
AU - Hoyt, Benjamin W.
AU - Imhoff, Andreas B.
AU - Itoi, Eiji
AU - Kilcoyne, Kelly G.
AU - Laedermann, Alexandre
AU - Lau, Brian C.
AU - Leclere, Lance E.
AU - Levine, William N.
AU - Martinez-Catalan, Natalia
AU - Matache, Bogdan A.
AU - McCarty, Eric C.
AU - Menendez, Mariano E.
AU - Millett, Peter J.
AU - Mirzayan, Raffy
AU - Moroder, Philipp
AU - Mullett, Hannan
N1 - Publisher Copyright:
© 2024 Arthroscopy Association of North America
PY - 2024
Y1 - 2024
N2 - Purpose: To establish consensus statements on the diagnosis, nonoperative management, and labral repair for posterior shoulder instability. Methods: A consensus process on the treatment of posterior shoulder instability was conducted, with 71 shoulder/sports surgeons from 12 countries participating on the basis of their level of expertise in the field. Experts were assigned to 1 of 6 working groups defined by specific subtopics within posterior shoulder instability. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement. Results: Unanimous agreement was reached on the indications for nonoperative management and labral repair, which include whether patients had primary or recurrent instability, with symptoms/functional limitations, and whether there was other underlying pathology, or patient's preference to avoid or delay surgery. In addition, there was unanimous agreement that recurrence rates can be diminished by attention to detail, appropriate indication and assessment of risk factors, recognition of abnormalities in glenohumeral morphology, careful capsulolabral debridement and reattachment, small anchors with inferior placement and multiple fixation points that create a bumper with the labrum, treatment of concomitant pathologies, and a well-defined rehabilitation protocol with strict postoperative immobilization. Conclusions: The study group achieved strong or unanimous consensus on 63% of statements related to the diagnosis, nonoperative treatment, and labrum repair for posterior shoulder instability. The statements that achieved unanimous consensus were the relative indications for nonoperative management, and the relative indications for labral repair, as well as the steps to minimize complications for labral repair. There was no consensus on whether an arthrogram is needed when performing advanced imaging, the role of corticosteroids/orthobiologics in nonoperative management, whether a posteroinferior portal is required. Level of Evidence: Level V, expert opinion.
AB - Purpose: To establish consensus statements on the diagnosis, nonoperative management, and labral repair for posterior shoulder instability. Methods: A consensus process on the treatment of posterior shoulder instability was conducted, with 71 shoulder/sports surgeons from 12 countries participating on the basis of their level of expertise in the field. Experts were assigned to 1 of 6 working groups defined by specific subtopics within posterior shoulder instability. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement. Results: Unanimous agreement was reached on the indications for nonoperative management and labral repair, which include whether patients had primary or recurrent instability, with symptoms/functional limitations, and whether there was other underlying pathology, or patient's preference to avoid or delay surgery. In addition, there was unanimous agreement that recurrence rates can be diminished by attention to detail, appropriate indication and assessment of risk factors, recognition of abnormalities in glenohumeral morphology, careful capsulolabral debridement and reattachment, small anchors with inferior placement and multiple fixation points that create a bumper with the labrum, treatment of concomitant pathologies, and a well-defined rehabilitation protocol with strict postoperative immobilization. Conclusions: The study group achieved strong or unanimous consensus on 63% of statements related to the diagnosis, nonoperative treatment, and labrum repair for posterior shoulder instability. The statements that achieved unanimous consensus were the relative indications for nonoperative management, and the relative indications for labral repair, as well as the steps to minimize complications for labral repair. There was no consensus on whether an arthrogram is needed when performing advanced imaging, the role of corticosteroids/orthobiologics in nonoperative management, whether a posteroinferior portal is required. Level of Evidence: Level V, expert opinion.
UR - http://www.scopus.com/inward/record.url?scp=85195263726&partnerID=8YFLogxK
U2 - 10.1016/j.arthro.2024.04.035
DO - 10.1016/j.arthro.2024.04.035
M3 - Article
C2 - 38735410
AN - SCOPUS:85195263726
SN - 0749-8063
JO - Arthroscopy - Journal of Arthroscopic and Related Surgery
JF - Arthroscopy - Journal of Arthroscopic and Related Surgery
ER -