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Clinical Outcomes After Arthroscopic 270° Labral Repair in Active-Duty Military Patients: At Minimum 10-Year
John K McNamara1, Alexis B Sandler1, John P Scanaliato1
1William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, Department of Orthopaedic Surgery and Rehabilitation, El Paso, Texas, USA.
Background:
Active-duty military servicemembers (ADSMs) exhibit a high prevalence of combined-type shoulder instability. Arthroscopic 270° labral repair has demonstrated promising outcomes at short- and intermediate-term follow-up, but there is a paucity of long-term outcomes data among ADSMs.
Purpose:
To report the outcomes of arthroscopic 270° labral repair at a minimum of 10-year follow-up in ADSMs.
Study Design:
Case series; Level of evidence: 4.
Methods:
A total of 44 ADSMs who underwent arthroscopic 270° labral repair between January 2010 and December 2012 without major concomitant procedures had ≥10 years of follow-up and were deemed eligible for inclusion. Of these, 38 were included in the final outcome analysis.
Results:
Mean follow-up was 140.4 ± 14.4 months. Postoperatively, there was a statistically significant improvement in pain visual analog scale (VAS) scores (8.3 ± 1.3 to 1.63 ± 2.29; P < .0001) as well as American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment (42.7 ± 12.3 to 87.3 ± 19.0; P < .0001), Single Assessment Numeric Evaluation (SANE) (49.5 ± 18.9 to 91.9 ± 11.3; P < .0001), and Rowe instability (45.3 ± 12.5 to 89.3 ± 19.2; P < .0001) scores. There were no significant differences observed between pre- and postoperative range of motion. At final follow-up, 95% of patients met the minimal clinically important difference threshold for VAS, 89% for ASES, 92% for SANE, and 92% for the Rowe score; 58% met the substantial clinical benefit threshold for VAS, 61% for ASES, 11% for SANE, and 74% for Rowe scores; and 74% met the Patient Acceptable Symptom State threshold for VAS, 76% for ASES, 76% for SANE, and 74% for Rowe scores. At final follow-up, 89.5% of patients (n = 34) either returned to unrestricted duty or left the military for reasons other than continued shoulder-related disability, while 86.8% (n = 33) returned to unrestricted physical training. Two patients (5.3%) underwent reoperation, one requiring revision anterior labral repair and the other Latarjet after a traumatic dislocation of the operative shoulder.
Conclusion:
Arthroscopic 270° labral repair demonstrates favorable clinical outcomes at a minimum 10-year postoperative follow-up in an active-duty military patient population, with clinically and statistically significant improvements in pain, patient-reported outcomes measures, and an overall return-to-duty rate of 89.5%.
