Occupational and functional outcomes of arthroscopic labral repair are not affected by concomitant extra-articular shoulder procedures

Background

The purpose of this study is to compare return to work (RTW), patient-reported outcomes, and complications in patients who underwent arthroscopic labral repair for anterior and posterior shoulder instability with and without concomitant extra-articular procedures.

Methods

This is a retrospective chart review of 535 consecutive patients who received arthroscopic labral repair for unidirectional shoulder instability between 2013 and 2020. Patients aged <17 years, with revision procedures, without documented dislocation/subluxation, and with multidirectional instability were excluded. Patients with the concomitant extra-articular procedures, such as biceps tenodesis (BT), rotator cuff repair (RCR), and distal clavicle excision (DCE), and those with >1 of these procedures were propensity score matched with isolated labral repairs based on age, sex, body mass index, and direction of instability (anterior or posterior). Outcomes included satisfaction, RTW, subsequent surgeries, recurrent instability, Patient-reported Outcomes Measures Information System – Upper Extremity, single alphanumeric evaluation, and American Shoulder and Elbow Surgeons scores.

Results

A total of 67 patients who met inclusion criteria, with 55 (82%) available for minimum 2-year follow-up (mean age: 34.6 years; range 17-62 years), including 30 BT, 10 RCR, 8 DCE, and 7 combination procedures. The matched control group included 53 patients (mean age: 32.2 years). There were no differences found between the BT (n = 36) and controls, RCR (n = 10) and controls, DCE (n = 12) and controls, nor combination (n = 7) and controls, in satisfaction, subsequent ipsilateral shoulder surgery, return to work (RTW), or recurrent instability. Similarly, single alphanumeric evaluation, American Shoulder and Elbow Surgeons, and Patient-reported Outcomes Measures Information System – Upper Extremity scores were all comparable at pre- and post-operative levels between BT and controls, RCR and controls, and DCE and controls.

Conclusion

Concomitant extra-articular procedures, including BT, DCE, and RCR, did not affect patient satisfaction, RTW, rates subsequent surgery, or recurrent instability when compared to patients undergoing isolated arthroscopic labral repair. Surgeons and patients can have confidence in performing these procedures concomitantly if they are felt to be indicated.