Arthroscopy-The Journal of Arthroscopic and Related Surgery最新文献

{"title":"The Sex or Race of Program Directors May Not Play a Significant Role in Impacting Diversity Among Orthopaedic Surgery Residents","authors":"Vani J. Sabesan M.D. ,&nbsp;Alessia Lavin M.D. ,&nbsp;Gabriel Lama B.S. ,&nbsp;Akshay V. Daji M.D. ,&nbsp;Clyde K. Fomunung B.S., M.B.A. ,&nbsp;Carlos A. Fernandez M.D. ,&nbsp;Garrett R. Jackson M.D. ,&nbsp;Lisa K. Cannada M.D.","doi":"10.1016/j.arthro.2024.03.036","DOIUrl":"10.1016/j.arthro.2024.03.036","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify the influence of residency program characteristics, including the presence of under-represented minorities in medicine (URiM) and/or female program directors (PDs), on the race and sex distribution of orthopaedic surgery residency trainees.</div></div><div><h3>Methods</h3><div>All active and Accreditation Council for Graduate Medical Education–accredited orthopaedic surgery residency programs from 2017-2021 that reported usable information in the Residency Explorer Tool were included. Data collected included program characteristics, as well as faculty and resident sex distribution, ethnicity, race, and demographic characteristics. The PDs’ specific sex, ethnicity, race, and demographic characteristics were collected using residency program websites. The prevalence of factors in programs with the top quartile of female and URiM residents was compared with that in programs with the bottom 3 quartiles.</div></div><div><h3>Results</h3><div>Data were obtained from 148 of 200 Accreditation Council for Graduate Medical Education–accredited programs (3,694 residents). The 52 excluded programs had no usable information in the Residency Explorer Tool or on an identifiable program website. Overall, 15.9% of residents in orthopaedic surgery residency programs were women and 14% were under-represented minorities. The rates of female PDs and chairs were 12.4% and 6.9%, respectively, whereas those of URiM PDs and chairs were 8.3% and 4.6%, respectively. Programs with more female residents were not associated with female PDs (<em>P</em> = .79) or URiM PDs (<em>P</em> = .48). Programs with a greater percentage of URiM residents were not associated with URiM PDs (<em>P</em> = .16). Larger programs (<em>P</em> = .021) and university-based programs (<em>P</em><span> = .048) had a greater percentage of female residents. Orthopaedic residency programs with visa sponsorship had a greater percentage of URiM residents (</span><em>P</em> = .017).</div></div><div><h3>Conclusions</h3><div>Programs with a higher percentage of female or URiM residents did not show a significant association with having female or URiM PDs. Larger programs and university-affiliated programs were more likely to have a larger percentage of female residents, whereas programs that offered visa sponsorship had a higher percentage of URiM residents.</div></div><div><h3>Clinical Relevance</h3><div>This study highlights factors influencing diversity among orthopaedic surgery residents. Although the presence of female or URiM PDs does not influence the percentage of female or URiM residents, other program characteristics such as size, affiliation, and visa sponsorship offer potentially actionable insights for promoting greater diversity in orthopaedic training. Doing so may increase under-represented groups within the field and could ultimately impact patient care and improve health care equity.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 279-285"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary: A Delphi Expert Consensus Provides Clarity on Diagnosis, Treatment, Rehabilitation, and Return-to-Sports for Posterior Shoulder Instability","authors":"Erik Hohmann M.B.B.S., F.R.C.S., F.R.C.S. (Tr.&Orth.), F.A.O.S.M.E., Ph.D., M.D. (Editorial Board)","doi":"10.1016/j.arthro.2024.06.009","DOIUrl":"10.1016/j.arthro.2024.06.009","url":null,"abstract":"<div><div>Posterior shoulder instability (PSI) is an uncommon condition, accounting for 2% to 12% of shoulder instability cases. However, PSI might be more common and possibly accounts for up to 24% of all young, active patients treated for shoulder instability. The etiology of PSI is complex and multifactorial, making accurate diagnosis, classification, and treatment challenging. The accurate diagnosis of PSI is problematic and varies with symptoms ranging from pain, decreased strength, or endurance to mechanical symptoms such as clicking or popping, and only a minority of patients present after a posterior shoulder dislocation. Appropriate imaging is necessary and should include radiographs and advanced imaging with magnetic resonance imaging, preferably magnetic resonance arthrography. The goal of treatment is to reduce pain, improve function, and prevent or reduce recurrence. Both surgical and conservative treatments are demanding, and both osseous and soft-tissue pathologies need to be addressed adequately. Typically, a conservative approach should be considered first for the first 6 months, with a focus on proprioceptive exercises, strengthening of the dynamic stabilizers, and improving scapulothoracic mechanics. The primary indication for surgery is recurrent symptoms. Controversies exist regarding the choice between open and arthroscopic stabilization of soft-tissue defects, the treatment of the McLaughlin lesion, and the management of osseous defects.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 196-198"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Crisis of Government Sponsored Healthcare in America.","authors":"Andrew S Neviaser","doi":"10.1016/j.arthro.2025.01.031","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.01.031","url":null,"abstract":"<p><p>Physicians and patients who participate in government-subsidized insurance face a looming crisis. The aging of the American population is producing ever increasing Medicare costs, and this crisis is not limited to federally run programs. Expansion of eligibility for Medicaid through the Affordable Care Act also produced increasing costs for this largely state-run program. Governmental cost containment efforts in healthcare have led to reductions in physician reimbursements, as well as increasing costs through added administrative burdens. When government insurers cut reimbursements, private insurers follow suit. This produces a decrease in dollars available, increases in costs, and more individuals needing care. As physicians, we have a moral obligation to provide care for those in need, but declining reimbursements and rising costs force physicians to limit access for Medicare and Medicaid patients. We need to educate the public as to why protecting health care spending is vital. There is no other group that can or will advocate for physicians, nor are there better advocates for the public health. If we do not act and advocate, this crisis will only worsen, and we will be forced to suffer the consequences of someone else's attempted solution. Physicians need to lobby for their patients to protect our ability to care for them. No one else will.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision Hip Arthroscopy Terrible Triad: Capsular Deficiency, Labral Deficiency, and Femoral Over-Resection","authors":"Joseph J. Ruzbarsky M.D. ,&nbsp;Ali Noorzad M.D. ,&nbsp;Nicholas A. Felan B.A. ,&nbsp;Marc J. Philippon M.D.","doi":"10.1016/j.arthro.2024.11.001","DOIUrl":"10.1016/j.arthro.2024.11.001","url":null,"abstract":"<div><div>Revision hip arthroscopy is increasingly common and most often performed to treat residual femoroacetabular impingement caused by cam under-resection. Unfortunately, other pathologies encountered during revision hip arthroscopy are more difficult to treat, including capsular deficiency, labral deficiency, adhesion formation, and/or cam over-resection. When encountered, these various pathologies should be comprehensibly corrected with the goals of restoring anatomy, re-establishing the hip fluid seal, and ensuring impingement-free motion. Labral deficiency can successfully be treated with labral augmentation or reconstruction. Capsular deficiency is best managed with primary repair or capsular reconstruction. Cam over-resection is a difficult problem, but there is growing evidence for a soft-tissue remplissage used to fill the defect with soft tissue. The combination of these problems can be considered a salvage scenario but can be treated comprehensively with these techniques with improved outcomes and acceptable survivorship.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 164-165"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary: Platelet-Rich Plasma for Rotator Cuff Repair Improves Retear Rate but Clinical Impact Is Yet to Be Seen","authors":"Zafar Ahmad M.D., F.R.C.S., F.S.E.M., F.E.B.O.T., M.Phil., M.R.C.S., M.B.B.S.,&nbsp;Michael Mckee M.D.","doi":"10.1016/j.arthro.2024.07.013","DOIUrl":"10.1016/j.arthro.2024.07.013","url":null,"abstract":"<div><div>Rotator cuff tendon repair has a high failure rate due to the inferior quality of tendon material. Platelet-rich plasma (PRP) is considered a potential solution, although its clinical impact is uncertain. Recent literature indicates that while PRP may reduce retear rates radiologically, it does not significantly improve clinical outcomes such as pain and function. Early animal studies showed potential benefits, but initial clinical trials were inconclusive due to small sample sizes and varied PRP methods. Larger, recent studies suggest a possible benefit, yet definitive clinical advantages remain elusive. Advancing PRP research requires a dual approach: deeper understanding of tendon and PRP biology, as well as larger clinical trials focusing on specific PRP preparations and delivery methods. While current evidence is limited, PRP holds promise for improving rotator cuff repair outcomes, and ongoing research may eventually translate into significant clinical benefits.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 302-303"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary: Arthroscopic Treatment of Mild Hip Dysplasia Can Result in Excellent Outcome and Avoid More Invasive Periacetabular Osteotomy","authors":"Benjamin G. Domb M.D. (Editorial Board) ,&nbsp;Isabella A. Wallace B.A. ,&nbsp;Nils Becker M.D.","doi":"10.1016/j.arthro.2024.10.023","DOIUrl":"10.1016/j.arthro.2024.10.023","url":null,"abstract":"<div><div>Several mechanisms either support or decrease stability of the hip joint. Primary stability of the hip comes from bony coverage of the femoral head, influenced by acetabular version and femoral antetorsion. In addition, soft tissue structures, such as the acetabular labrum, the ligamentum teres, and the hip capsule play a significant role in maintaining joint stability. Untreated hip instability may lead to pathological force transmission between the acetabular socket and femoral head, and subluxation resulting in osteoarthritis. Historically, pelvic and/or femoral osteotomies have been performed to increase hip stability and prevent joint degeneration. However, osteotomies do not address soft tissue instability or lesions of intra-articular structures, which could explain symptoms following bony correction. Furthermore, the rate of combined pathologies resulting in hip instability and femoroacetabular impingement syndrome (FAIS) is high. Modern hip arthroscopy enables reconstruction and stabilization of soft tissue structures and the correction of bony pathologies caused by FAIS. Minimally invasive procedures can help avoid overtreatment and unnecessary risks associated with more invasive osteotomies. However, in cases of ongoing symptoms after arthroscopic treatment for mild instability, or for patients with severe dysplasia, concomitant PAO and arthroscopy can combine bony correction of a PAO with intra-articular therapies of hip arthroscopy.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 226-228"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mesenchymal Stem Cells Injection Is More Effective Than Hyaluronic Acid Injection in the Treatment of Knee Osteoarthritis With Similar Safety: A Systematic Review and Meta-analysis","authors":"Wen-shu Jin M. Med. ,&nbsp;Lu-xu Yin M.D. ,&nbsp;Hua-qiang Sun M.D. ,&nbsp;Zhang Zhao M.D. ,&nbsp;Xin-feng Yan M.D.","doi":"10.1016/j.arthro.2024.07.027","DOIUrl":"10.1016/j.arthro.2024.07.027","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the efficacy and safety of intra-articular injection of mesenchymal stem cells (MSCs) versus hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA).</div></div><div><h3>Methods</h3><div>Eligible randomized controlled trials (RCTs) were identified through a search of PubMed, Embase, the Cochrane Library, Web of Science, SinoMed, and CNKI databases from inception to March 2024. For meta-analysis, data on clinical outcomes were measured using visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and data on cartilage repair were measured using the Whole-Organ Magnetic Resonance Imaging Score (WORMS); data on safety were evaluated by the incidence of adverse events. Two researchers independently read the included literature, extracted data and evaluated the quality, used the Cochrane risk bias assessment tool for bias risk assessment, and used RevMan5.3 software for meta-analysis.</div></div><div><h3>Results</h3><div>Ten RCTs involving 818 patients with KOA ranging from I to Ⅲ on the Kellgren-Lawrence grading scale were included in this meta-analysis. Meta-analysis results showed that at 12 months, the WOMAC total score (mean difference [MD] = –10.22, 95% confidence interval [CI]: –14.86 to –5.59, <em>P</em> &lt; .0001, <em>Z</em> = 4.32), VAS score (MD = –1.31, 95% CI: –1.90 to –0.73, <em>P</em> &lt; .0001, <em>Z</em> = 4.40); and WORMS score (MD = –26.01, 95% CI: –31.88 to –20.14, <em>P</em> &lt; .001, <em>Z</em> = 8.69) of the MSCs group all decreased significantly (<em>P</em> &lt; .05) compared with the HA control group and reached the minimal clinically important differences. Furthermore, there was no significant difference in the incidence of adverse events (relative risk = 1.54, 95% CI: 0.85–2.79, <em>P</em> = .16, <em>I</em>² = 0) between the 2 groups (<em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>In terms of efficacy, the clinical effects of intra-articular injection therapy using MSCs for KOA are superior to those of HA, and the cartilage repair effect of MSCs is also markedly better than that of HA. Although the clinical effects varied across time periods, the functional score reached the minimum clinically significant difference at both 6 and 12 months. In terms of safety, adverse reactions mainly manifest as joint pain, swelling, and joint effusion. Both intra-articular injections of MSCs and HA did not result in severe adverse reactions, indicating that MSCs and HA have similar safety profiles.</div></div><div><h3>Level of Evidence</h3><div>Level I, meta-analysis of Level I studies.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 318-332"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients With a History of Lumbar Fusion Have a Greater Risk of Revision Arthroscopy and Conversion to Total Hip Arthroplasty After Primary Hip Arthroscopy","authors":"Abhinaba Chatterjee M.D. ,&nbsp;Kaisen Yao M.D. ,&nbsp;Matthew H. Nasra M.D. ,&nbsp;Thun Itthipanichpong M.D. ,&nbsp;Gregory Galano M.D. ,&nbsp;Anil S. Ranawat M.D.","doi":"10.1016/j.arthro.2024.08.026","DOIUrl":"10.1016/j.arthro.2024.08.026","url":null,"abstract":"<div><h3>Purpose</h3><div>To characterize the risk of revision hip arthroscopy or conversion to total hip arthroplasty (THA) among patients with a history of lumbar fusion undergoing primary hip arthroscopy.</div></div><div><h3>Methods</h3><div>We used the Statewide Planning and Research Cooperative System, an administrative database including all ambulatory and inpatient surgery encounters in New York, to identify all patients who underwent hip arthroscopy for femoroacetabular impingement between 2010 and 2020. Patients with previous lumbar fusion were identified using Current Procedural Terminology and <em>International Classification of Diseases</em>, <em>Ninth</em> and <em>Tenth Revision</em>, coding definitions. Patients with and without previous fusion were matched in a 1:5 ratio according to age and comorbidity burden. The number of levels fused was defined in the following fashion: (1) no fusion, (2) 1-2 levels, or (3) ≥3 levels. Patients were followed for 2 years to evaluate the rate of revision hip arthroscopy or conversion to THA. Multivariable logistic regression models were used to measure the association between number of levels fused and revision hip arthroscopy or conversion to THA.</div></div><div><h3>Results</h3><div>Between 2010 and 2020, there were 23,277 patients who underwent primary hip arthroscopy in New York state. Of these, 348 (1.4%) had a previous lumbar fusion. After matching for age and comorbidities, the composite rate of revision hip arthroscopy or conversion to THA was greater in patients with previous lumbar fusion compared with patients without (16.5% vs 8.5%; <em>P</em> &lt; .001). This risk increased with the number of levels fused (1-2 levels: 15.1%; adjusted odds ratio, 1.8; 95% confidence interval 1.3-2.6; vs ≥3 levels: 26.3%; adjusted odds ratio, 3.4; 95% confidence interval 1.7-7.0).</div></div><div><h3>Conclusions</h3><div>Patients with a history of lumbar fusion had significantly greater rates of revision hip arthroscopy and conversion to THA compared with patients without previous fusion. The risk of revision hip arthroscopy or conversion to THA was increased approximately 2-fold in patients with 1 to 2 levels fused and 3-fold in patients with 3 or more levels fused.</div></div><div><h3>Level of Evidence</h3><div>Level III, prognostic retrospective matched comparative case series.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 229-234"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Podium Presentation Title: Ten-Year Outcomes After Endoscopic Gluteus Medius Repair","authors":"Payam Sabetian M.D.,&nbsp;Benjamin G. Domb M.D.","doi":"10.1016/j.arthro.2024.11.017","DOIUrl":"10.1016/j.arthro.2024.11.017","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Page e6"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143128432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Shoulder Instability, Part II—Glenoid Bone Grafting, Glenoid Osteotomy, and Rehabilitation/Return to Play—An International Expert Delphi Consensus Statement","authors":"Eoghan T. Hurley M.D., Ph.D. ,&nbsp;Zachary S. Aman M.D. ,&nbsp;Tom R. Doyle M.B., M.Ch. ,&nbsp;Jay M. Levin M.D., M.B.A. ,&nbsp;Bogdan A. Matache MD, CM, FRCSC ,&nbsp;Peter N. Chalmers MD ,&nbsp;Brian R. Waterman MD ,&nbsp;Brandon J. Erickson MD ,&nbsp;Christopher S. Klifto M.D. ,&nbsp;Oke A. Anakwenze M.D., M.B.A. ,&nbsp;Jonathan F. Dickens M.D.","doi":"10.1016/j.arthro.2024.04.034","DOIUrl":"10.1016/j.arthro.2024.04.034","url":null,"abstract":"<div><h3>Purpose</h3><div>To establish consensus statements on glenoid bone grafting, glenoid osteotomy, rehabilitation, return to play, and follow-up for posterior shoulder instability.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>All of the statements relating to rehabilitation, return to play, and follow-up achieved consensus. There was unanimous consensus that the following criteria should be considered: restoration of strength, range of motion, proprioception, and sport-specific skills, with a lack of symptoms. There is no minimum time point required to return to play. Collision athletes and military athletes may take longer to return because of their greater risk for recurrent instability, and more caution should be exercised in clearing them to return to play, with elite athletes potentially having different considerations in returning to play. The relative indications for revision surgery are symptomatic apprehension, multiple recurrent instability episodes, further intra-articular pathologies, hardware failure, and pain.</div></div><div><h3>Conclusions</h3><div>The study group achieved strong or unanimous consensus on 59% of statements. Unanimous consensus was reached regarding the criteria for return to play, collision/elite athletes having different considerations in return to play, indications for revision surgery, and imaging only required as routine for those with glenoid bone grafting/osteotomies at subsequent follow-ups. There was no consensus on optimal fixation method for a glenoid bone block, the relative indications for glenoid osteotomy, whether fluoroscopy is required or if the labrum should be concomitantly repaired.</div></div><div><h3>Level of Evidence</h3><div>Level V, expert opinion.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 181-195.e7"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}