Arthroscopic Findings and Clinical Outcomes in Patients 40 Years of Age and Older With Recurrent Shoulder Dislocation

Abstract

Purpose: The present study investigates the intra-articular findings and clinical outcomes after arthroscopic surgery in patients after age 40 with chronic anterior shoulder instability.

Methods: Fifty patients older than 40 years who underwent arthroscopic stabilization for recurrent anterior shoulder dislocation were analyzed.

Results: The mean age at the time of surgery was 44.8 years (range, 40-72 years), and the mean duration of follow-up was 45 months (range, 28-150 months). The mean visual analog scale score for pain with motion significantly improved from 4.1 preoperatively to 1.7 at the last follow-up (P < .001). The range of motion in the affected shoulder revealed limitations of 9.4° in forward flexion and 17.8° in external rotation compared with the unaffected shoulder. Both the Constant and Rowe scores significantly improved (P < .001 and P < .001, respectively). Recurrence, which includes dislocation and subluxation, occurred in 14% postoperatively. Anteroinferior labral lesion was seen in 92% of patients. Associated lesions included superior labrum anterior to posterior lesion (22%), midsubstance capsular tear (10%), and Hill-Sachs lesion (92%). Rotator cuff tears were found in 18%-partial-thickness tear in 10% and full-thickness tear, which was repaired with suture anchor, in 8%. Among the intra-articular lesions, there was no significant relation with recurrent instability or functional outcome as a single factor.

Conclusions: In patients with chronic anterior shoulder instability who were older than 40 years, the clinical results after arthroscopic surgery showed statistically significant improvement with good muscle strength recovery. The quality of labral lesion, size of the Hill-Sachs lesion, and glenoid defect showed positive correlation with the number of preoperative dislocation. The intra-articular pathologies were varied, however no single articular lesion had significant impact on the recurrence rate.

Level of evidence: Level IV, case series.