Article

The management of posterior shoulder instability remains
controversial. Consequently,
for a symposium on this topic,
the French
Arthroscopy Society (SFA) conducted a prospective multicentre study comparing
outcomes of operative and non-operative treatment. OBJECTIVE: To compare outcomes
after operative versus non-operative treatment of posterior shoulder instability.
HYPOTHESIS: The surgical treatment of posterior shoulder instability may achieve
better clinical outcomes than non-operative treatment in selected patients.
METHODS: Fifty-one patients were included prospectively then
followed-up for 12months. Three groups were defined based on the clinical
presentation: recurrent dislocation or subluxation, involuntary instability or
voluntary instability that had become involuntary, and shoulder pain with
instability. Of the 51 patients, 19 received non-operative therapy involving a
three-step rehabilitation programme and 32 underwent surgery with a posterior
bone block, labral repair and/orcapsule tightening, or bone defect filling. At
inclusion and at last follow-up, the Subjective Shoulder Value (SSV), Rowe score,
Walch-Duplay score, and Constant score were determined. RESULTS: The preliminary
results after the first 12 months are reported here. In the non-operative and
operative groups, the Constant score was 78 versus 87, the Rowe score 64 versus
88, and the Walch-Duplay score 69 versus 82, respectively. These differences were
statistically significant (P<0.05). DISCUSSION:
To our knowledge, this study is
the first comparison of non-operative versus operative treatment in a cohort of
patients with documented posterior shoulder instability. Outcomes were better
with operative treatment. However, this finding remains preliminary given the
short follow-up of only 1 year. LEVEL OF EVIDENCE: III, case-control study.
CI - Copyright (c) 2017 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS