Biceps Tenodesis Combined With Arthroscopic Posterior Labral Repair for Type VIII SLAP Lesions in Active-Duty Military Patients Yields Excellent Return to Military Duty

Surgical treatment of long head of biceps pathology: analyzing trends in the United States from 2010 to 2019

Background

The long head of the biceps tendon (LHBT) is a common cause of anterior shoulder pain. A symptomatic LHBT is commonly encountered in the setting of a rotator cuff tear. The purpose of this study was to determine trends in the incidence of isolated tenotomy and tenodesis procedures for symptomatic LHBT in the setting of rotator cuff repairs (RCR).

Methods

The MarketScan database was queried from 2010 to 2019 for biceps tenotomy (open) and tenodesis (open and arthroscopic) in the United States. Annual procedure volumes and incidences were calculated using discharge weights and U.S. Census Bureau data, respectively. Further subgroup analysis included age, gender, and region.

Results

Open tenodesis remained the most common procedure in the United States for isolated LHBT management. Its incidence increased by 180% from 2010 to 2019, accounting for 49% of isolated LHBT procedures by 2019. In the setting of RCR, arthroscopic tenodesis was most common, and its incidence grew by 138%. By 2019, arthroscopic tenodesis accounted for 58% of procedures in the setting of RCR, while tenotomy claimed only 2%. The incidence of all procedures increased for the age ≥65 cohort, with a notable 828% increase in the incidence of open tenodesis as an isolated procedure, accounting for 76% of procedures by 2019.

Conclusion

Volumes of procedures aimed to ameliorate LHBT pathology increased from 2010 to 2019. Open tenodesis remained the preferred procedure for isolated LHBT pathology, while arthroscopic tenodesis was preferred in the setting of concomitant RCR. Future research can develop algorithmic approaches to treating biceps pathology.

Midterm Outcomes After Revision Posterior Labral Repair in Active-Duty Military Patients

Background

Active-duty military service members experience posterior glenohumeral instability at a rate that far outpaces that of nonmilitary populations. While the outcomes after primary posterior labral repair (PLR) in this population are promising, the outcomes after revision procedures remain poorly described.

Purpose

To report midterm outcomes after revision PLR in a population of active-duty military patients.

Study Design

Case series; Level of evidence, 4.

Methods

Patients who underwent revision PLR from January 2011 through December 2018 by the senior surgeon with a minimum of 5 years of follow-up were deemed eligible for inclusion. Preoperative and postoperative outcome scores for the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), and the Rowe instability score as well as the rates of return to active duty and sports and the rate of recurrent instability were collected and pooled for analysis.

Results

Overall, 21 patients with a mean follow-up of 77.95 ± 39.54 months met inclusion criteria and were available for analysis. At midterm follow-up, patients who underwent revision PLR experienced significantly improved VAS (from 7.3 ± 1.8 to 2.9 ± 2.4), ASES (from 49.5 ± 12.6 to 79.7 ± 16.7), SANE (from 45.0 ± 14.8 to 80.2 ± 20.3), and Rowe (from 37.6 ± 9.4 to 79.4 ± 24.7) scores. Over 80% of patients also achieved the minimal clinically important difference for these outcome measures; however, only 52% to 62% of patients achieved the Patient Acceptable Symptom State. The return-to-sport rate was 66.67%, and the return to active-duty rate was 80.95%.

Conclusion

While patients who underwent revision PLR experienced improvements in outcomes and a decrease in pain on average, they exhibited rates of return to active-duty and sports that lagged behind those demonstrated in a previous cohort that underwent a primary procedure. Furthermore, the achievement of clinically significant outcomes after revision PLR was less consistent compared with that after primary PLR.

Establishing Clinical Significance for Patients Undergoing Arthroscopic Repair of Type II SLAP Lesions

Background

Type II superior labrum anterior to posterior (SLAP) lesions may be treated with either arthroscopic repair or biceps tenodesis. There are no previous reports of measures of clinically significant improvement after arthroscopic repair of SLAP lesions.

Purpose

To establish the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) for patients undergoing arthroscopic repair for type II SLAP lesions.

Study Design

Case series; Level of evidence, 4.

Methods

A total of 69 arthroscopic repair procedures for isolated type II SLAP lesions were performed in a military population. The mean age was 28.1 ± 4.7 years, 97.1% were male, and the mean follow-up was 99.5 ± 19.7 months. The MCID, PASS, and SCB were calculated for each patient-reported outcome measure, consisting of the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain, using anchor- and distribution-based models. Factors associated with achieving a clinically relevant improvement were also determined.

Results

The MCID, PASS, and SCB for each measure were as follows: 7.7, 70, and 34 for the ASES score, respectively; 10.4, 80, and 45 for the SANE, respectively; and 1.0, 4, and 6 for the VAS pain, respectively. At least 85% of patients achieved the MCID for each measure; however, PASS rates were lower, with 50.7% for the SANE and 69.6% for both the ASES score and VAS pain. The ASES score had the highest percentage of patients achieving the SCB at 44.9%, followed by the SANE (26.1%) and VAS pain (10.1%). Greater forward flexion at final follow-up was associated with achieving the MCID and PASS for both the ASES score and SANE. Internal rotation stiffness at final follow-up was negatively associated with achieving the PASS for the VAS pain. Combat arms military occupational specialty was associated with a lesser likelihood of achieving the SCB for the ASES score.

Conclusion

Clinical metrics of improvement were defined for the ASES score, SANE, and VAS pain using the MCID, PASS, and SCB for patients undergoing arthroscopic repair of type II SLAP lesions. Better final range of motion was positively associated with achieving improvement, while high-intensity military duty was negatively associated.

Return to military duty following anterior cruciate ligament reconstruction is associated with preoperative Body Mass Index and postoperative physiotherapy

PURPOSE

To determine the rate and time of return to duty following anterior cruciate ligament reconstruction (ACLR) in military members, and to determine whether their outcomes are influenced by patient characteristics or surgical parameters.

METHODS

We prospectively assessed 280 military members that underwent ACLR. 27 were excluded due to multi-ligamentous injuries or revision surgery, two did not provide informed consent and 62 were lost to follow-up. Patient demographics, pre-injury physical workload, complications and whether/when patients resumed duty and sports were noted, as well as clinical outcomes at a minimum follow-up of one year, including Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee score (IKDC), Lysholm, and Tegner scale.

RESULTS

The final cohort of 189 military members (82% men) had mean age of 25.5 ± 3.4 (range,19-38) at ACLR. At 3.3 ± 1.6 years (range, 1.0-6.3), the Tegner score was 6.1 ± 2.0, Lysholm was 87.0 ± 13.7, IKDC was 80.1 ± 15.7, and KOOS was 81.1 ± 14.8. Only 144 patients (76%) resumed duty, at 9.5 ± 5.3 months (range,1-28), and 141 patients (75%) resumed sport, at 10.2 ± 6.2 months (range,1-35). Multivariable analysis revealed that return to duty was less likely in patients with higher BMI (OR,0.89;p = 0.025), but more likely in patients that followed military physiotherapy (OR,2.76;p = 0.017) and with higher pre-injury physical workload (OR,3.93;p = 0.010).

CONCLUSION

At a follow-up of 3.3 ± 1.6 years, 76% returned to duty at 9.5 ± 5.3 months, and 75% returned to their main sport at 10.2 ± 6.2 months. Patients with higher BMI are significantly less likely to resume military duty and sports; those that followed military physiotherapy were most likely to resume duty, while those that had greater pre-injury physical workload were more likely to both resume duty and sport.

Establishing the Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State After Arthroscopic Posterior Labral Repair for Posterior Glenohumeral Instability

BACKGROUND

Posterior glenohumeral instability is an increasingly recognized cause of shoulder pain and dysfunction among young, active populations. Outcomes after posterior stabilization procedures are commonly assessed using patient-reported outcome measures including the Single Assessment Numeric Evaluation (SANE), the Rowe instability score, the American Shoulder and Elbow Surgeons (ASES) score, and the visual analog scale (VAS) for pain. The clinical significance thresholds for these measures after arthroscopic posterior labral repair (aPLR), however, remain undefined.

PURPOSE

We aimed to define the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for the SANE, Rowe score, and ASES score as well as the VAS pain after aPLR. Additionally, we sought to determine preoperative factors predictive of reaching, as well as failing to reach, clinical significance.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

This study was a retrospective analysis of patient-reported outcome scores collected from patients who underwent aPLR between January 2011 and December 2018. To determine the clinically significant threshold that corresponded to achieving a meaningful outcome, the MCID, SCB, and PASS were calculated for the SANE, Rowe score, ASES score, and VAS pain utilizing either an anchor- or distribution-based method. Additionally, univariate and multivariate logistic regression analyses were performed to determine the factors associated with achieving, or not achieving, the MCID, SCB, and PASS.

RESULTS

A total of 73 patients with a mean follow-up of 82.55 ± 24.20 months were available for final analysis. MCID, SCB, and PASS values for the VAS pain were 1.10, 6, and 3, respectively; for the ASES score were 7.8, 34, and 80, respectively; for the SANE were 10.15, 33, and 85, respectively; and for the Rowe score were 11.3, 60, and 90, respectively. To meet the MCID, male sex (odds ratio [OR], 1.1639; P = .0293) was found to be a positive predictor for the VAS pain, and a lower preoperative SANE score (OR, 0.9939; P = .0003) was found to be a negative predictor for the SANE. Dominant arm involvement was associated with lower odds of achieving the PASS for the ASES score (OR, 0.7834; P = .0259) and VAS pain (OR, 0.7887; P = .0436). Patients who reported a history of shoulder trauma were more likely to reach the PASS for the SANE (OR, 1.3501; P = .0089), Rowe score (OR, 1.3938; P = .0052), and VAS pain (OR, 1.3507; P = .0104) as well as the SCB for the ASES score (OR, 1.2642; P = .0469) and SANE (OR, 1.2554; P = .0444). A higher preoperative VAS pain score was associated with higher odds of achieving the SCB for both the VAS pain (OR, 1.1653; P = .0110) and Rowe score (OR, 1.1282; P = .0175). Lastly, concomitant biceps tenodesis was associated with greater odds of achieving the SCB for the ASES score (OR, 1.3490; P = .0130) and reaching the PASS for the SANE (OR, 1.3825; P = .0038) and Rowe score (OR, 1.4040; P = .0035).

CONCLUSION

To our knowledge, this study is the first to define the MCID, SCB, and PASS for the ASES score, Rowe score, SANE, and VAS pain in patients undergoing aPLR. Furthermore, we found that patients who reported a history of shoulder trauma and those who underwent concomitant biceps tenodesis demonstrated a greater likelihood of achieving clinical significance. Dominant arm involvement was associated with lower odds of achieving clinical significance.

Concomitant Biceps Tenodesis Does Not Portend Inferior Outcomes After Anterior Glenohumeral Stabilization

BACKGROUND

Military patients are known to suffer disproportionately high rates of glenohumeral instability as well as superior labrum anterior to posterior (SLAP) tears. Additionally, a concomitant SLAP tear is frequently observed in patients with anterior shoulder instability. Even though biceps tenodesis has been demonstrated to produce superior outcomes to SLAP repair in military patients with isolated SLAP lesions, no existing studies have reported on outcomes after simultaneous tenodesis and anterior labral repair in patients with co-existing abnormalities.

PURPOSE

To evaluate outcomes after simultaneous arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair in military patients younger than 40 years. We also sought to compare these outcomes with those after repair of an isolated anterior labral tear.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

This study is a retrospective analysis of all military patients younger than 40 years from a single base who underwent arthroscopic anterior glenohumeral stabilization with or without concomitant biceps tenodesis between January 2010 and December 2019. Patients with glenoid bone loss of >13.5% were not eligible for inclusion. Outcome measures including the visual analog scale (VAS) for pain, the Single Assessment Numeric Evaluation (SANE), the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Rowe instability score, and range of motion were administered preoperatively and postoperatively, and scores were compared between groups.

RESULTS

A total of 82 patients met inclusion criteria for the study. All patients were active-duty service members at the time of surgery. The mean follow-up was 87.75 ± 27.05 months in the repair + tenodesis group and 94.07 ± 28.72 months in the isolated repair group (P = .3085). Patients who underwent repair + tenodesis had significantly worse preoperative VAS pain (6.85 ± 1.86 vs 5.02 ± 2.07, respectively; P < .001), ASES (51.78 ± 11.89 vs 62.43 ± 12.35, respectively; P = .0002), and Rowe (26.75 ± 7.81 vs 37.26 ± 14.91, respectively; P = .0002) scores than patients who underwent isolated repair. Both groups experienced significant improvements in outcome scores postoperatively (P < .0001 for all), and there were no statistically significant differences in postoperative outcome scores or range of motion between groups. There were no differences in the percentage of patients who achieved the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state for the VAS pain, SANE, ASES, and Rowe scores between groups. Overall, 37 of the 40 (92.50%) patients in the repair + tenodesis group and 40 of the 42 (95.24%) patients in the isolated repair group returned to unrestricted active-duty military service (P = .6045). In addition, 38 (95.00%) patients in the repair + tenodesis group and 40 (95.24%) patients in the isolated repair group returned to preinjury levels of sporting activity (P = .9600). There were no significant differences in the number of failures, revision surgical procedures, or patients discharged from the military between groups (P = .9421, P = .9400, and P = .6045, respectively).

CONCLUSION

The findings of this study indicate that simultaneous biceps tenodesis and labral repair was a viable treatment option for the management of concomitant SLAP and anterior labral lesions in young, active military patients younger than 40 years.

A Comparative Analysis Between Conservative Treatment, Arthroscopic Repair, and Biceps Tenodesis in Superior Labral Anterior-Posterior (SLAP) Lesions

Background "Throwing shoulder" hinders athletes' shoulder functions, causing pain, weakness, and performance reduction due to anatomical, physiological, and biomechanical factors. Anatomical issues include superior labral anterior-posterior (SLAP) injuries, rotator cuff injuries, and glenohumeral instability. Methods This study compared arthroscopic labral repairs in patients under 40 years old with shoulder injuries between 2015 and 2017. Sixty eligible patients were divided into three groups: conservative treatment, arthroscopic repair, and tenodesis. Measures included pain, functional scores, and the range of motion pre-/post-operation. Results At the last follow-up, pain relief and functional improvement were most significant with tenodesis (97% pain relief, 95% functional improvement), followed by repair (85% pain relief, 70% functional improvement), and least in conservative treatment (45% pain relief, 40% functional improvement). While all treatments significantly reduced pain and improved function (p<0.001), tenodesis demonstrated the highest effectiveness, suggesting it as a potentially preferred method. Significant improvements in pain relief and function were observed across all methods; however, surgical options suggested improved outcomes. Conclusion Our study compares conservative treatment, arthroscopic labral repair, and biceps tenodesis (BT) for SLAP lesions, highlighting significant pain relief and functional improvement across all. Conservative treatment suits patients with milder symptoms, while arthroscopic repair addresses larger tears. As the effectiveness of arthroscopic treatment is not inferior to conservative one, BT excels in cases of substantial bicep involvement.

Simultaneous Arthroscopic Rotator Cuff Repair and Glenoid Microfracture in Active-Duty Military Patients Younger Than 50 Years: Outcomes at Midterm Follow-up

Background

While concomitant full-thickness rotator cuff tears and glenoid osteochondral defects are relatively uncommon in younger patients, military patients represent a unique opportunity to study this challenging injury pattern.

Purpose/Hypothesis

To compare the outcomes of young, active-duty military patients who underwent isolated arthroscopic rotator cuff repair (ARCR) with those who underwent ARCR plus concurrent glenoid microfracture (ARCR+Mfx). It was hypothesized that ARCR+Mfx would produce significant improvements in patient-reported outcome measures.

Study Design

Cohort study; Level of evidence, 3.

Methods

This was a retrospective analysis of consecutive active-duty military patients from a single base who underwent ARCR for full-thickness rotator cuff tears between January 2012 and December 2020. All patients were <50 years and had minimum 2-year follow-up data. Patients who underwent ARCR+Mfx were compared with those who underwent isolated ARCR based on the visual analog scale (VAS) for pain, Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) shoulder score, and range of motion.

Results

A total of 88 patients met the inclusion criteria for this study: 28 underwent ARCR+Mfx and 60 underwent isolated ARCR. The mean final follow-up was 74.11 ± 33.57 months for the ARCR+Mfx group and 72.87 ± 11.46 months for the ARCR group (P = .80). There were no differences in baseline patient characteristics or preoperative outcome scores between groups. Postoperatively, both groups experienced statistically significant improvements in all outcome scores (P < .0001 for all). However, the ARCR+Mfx group had significantly worse VAS pain (1.89 ± 2.22 vs 1.03 ± 1.70; P = .05), SANE (85.46 ± 12.99 vs 91.93 ± 12.26; P = .03), and ASES (86.25 ± 14.14 vs 92.85 ± 12.57; P = .03) scores. At the final follow-up, 20 (71.43%) patients in the ARCR+Mfx group and 53 (88.33%) patients in the ARCR group were able to remain on unrestricted active-duty military service (P = .05).

Conclusion

Concomitant ARCR+Mfx led to statistically and clinically significant improvements in patient-reported outcome measures at the midterm follow-up. However, patients who underwent ARCR+Mfx had significantly worse outcomes and were less likely to return to active-duty military service than those who underwent isolated ARCR. The study findings suggest that ARCR+Mfx may be a reasonable option for young, active patients who are not candidates for arthroplasty.

Arthroscopic Posterior Labral Repair for Posterior Shoulder Instability

Background

Posterior shoulder instability occurs in 2% to 10% of shoulder instability cases and is more commonly due to repetitive microtrauma as opposed to the more traumatic onset seen in anterior shoulder instability. In posterior instability, the posterior capsulolabral complex becomes attenuated or torn. Thus, surgical treatment aims to restore the posterior soft-tissue stabilizers typically with an arthroscopic, suture-anchor-based labral repair.

Indications

Surgical indications include posterior instability with traumatic cause and associated soft-tissue and/or osseous pathology and for those patients with repetitive microtrauma who have failed nonsurgical management.

Technique Description

Following diagnostic arthroscopy, the glenoid is prepared using an arthroscopic elevator, rasp, and chisel first viewing from the posterior portal, then from the anterior portal using a 70° arthroscope. An all-suture anchor is placed at the 7 o'clock position using a curved guide which obviates the need for an accessory 7 o'clock portal. The repair suture is then shuttled through the labrum using a suture lasso and monofilament. This repair suture is then shuttled through the suture anchor using the inbuilt shuttling fiberlink. The repair suture is then tightened to secure the labrum. The remainder of the repair uses knotless 2.9-mm biocomposite suture anchors and free suture tape as the all-suture anchor and associated curved guide are typically only necessary for the angle of the most inferior portal. Following a 3 to 5 anchor repair, the posterior portal capsular rent is closed to avoid leaving a stress riser. Posterior capsular closure is achieved using monofilament suture passed with a birdbeak and tied blindly in the subacromial space.

Results

In a study of 200 shoulders at 36 months, patients undergoing posterior stabilization had improvements in their American Shoulder and Elbow Surgeons (ASES) scores and improvements in stability, pain and function. Ninety percent of patients were able to return to sport and 64% of patients returned to the same level. Failure rate was low at 6%.

Discussion/Conclusion

Posterior labral repair is a technically nuanced but reliable procedure for the management of posterior instability.

Patient Consent Disclosure Statement

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Midterm Outcomes Following Combined Biceps Tenodesis and Anterior Labral Repair in Active Duty Military Patients Younger than 35 Years

BACKGROUND

Superior labrum anterior-posterior (SLAP) lesions and anterior instability are common causes of shoulder pain and dysfunction among active-duty members of the United States military. However, little data have been published regarding the surgical management of type V SLAP lesions.

PURPOSE

To compare the outcomes of arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair with those of arthroscopic SLAP repair (defined as contiguous repair spanning from the superior labrum to the anteroinferior labrum) for type V SLAP tears in active-duty military patients younger than 35 years.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

All consecutive patients from January 2010 to December 2015 who underwent arthroscopic SLAP repair or combined biceps tenodesis and anterior labral repair for a type V SLAP lesion with a minimum 5-year follow-up were identified. The decision to perform type V SLAP repair versus combined biceps tenodesis and anterior labral repair was based on the condition of the long head of the biceps tendon (LHBT). Labral repair was performed in patients who had a type V SLAP tear with an otherwise clinically and anatomically healthy LHBT. Combined tenodesis and repair was performed in patients with evidence of LHBT abnormalities. Outcomes including the visual analog scale (VAS) score, the Single Assessment Numeric Evaluation (SANE) score, the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Rowe instability score, and range of motion were collected preoperatively and postoperatively, and scores were compared between the groups.

RESULTS

A total of 84 patients met the inclusion criteria for the study. All patients were active-duty service members at the time of surgery. A total of 44 patients underwent arthroscopic type V SLAP repair, and 40 patients underwent anterior labral repair with biceps tenodesis. The mean follow-up was 102.59 ± 20.98 months in the repair group and 94.50 ± 27.11 months in the tenodesis group (P = .1281). There were no significant differences in preoperative range of motion or outcome scores between the groups. Both groups experienced statistically significant improvements in outcome scores postoperatively (P < .0001 for all); however, compared with the repair group, the tenodesis group reported significantly better postoperative VAS (2.52 ± 2.36 vs 1.50 ± 1.91, respectively; P = .0328), SANE (86.82 ± 11.00 vs 93.43 ± 8.81, respectively; P = .0034), and ASES (83.32 ± 15.31 vs 89.90 ± 13.31, respectively; P = .0394) scores. There were no differences in the percentage of patients who achieved the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state for the SANE and ASES between the groups. Overall, 34 patients in each group returned to preinjury levels of work (77.3% vs 85.0%, respectively; P = .3677), and 32 patients (72.7%) in the repair group and 33 patients (82.5%) in the tenodesis group returned to preinjury levels of sporting activity (P = .2850). There were no significant differences in the number of failures, revision surgical procedures, or patients discharged from the military between the groups (P = .0923, P = .1602, and P = .2919, respectively).

CONCLUSION

Both arthroscopic-assisted subpectoral biceps tenodesis combined with anterior labral repair and arthroscopic SLAP repair led to statistically and clinically significant increases in outcome scores, marked improvements in pain, and high rates of return to unrestricted active duty in military patients with type V SLAP lesions. The results of this study suggest that biceps tenodesis combined with anterior labral repair produces comparable outcomes to arthroscopic type V SLAP repair in active-duty military patients younger than 35 years.

Simultaneous Arthroscopic Glenohumeral Stabilization and Glenoid Microfracture in Young, Active-Duty Military Patients: Outcomes at 5-Year Follow-up

Background

Glenohumeral instability represents a common cause of shoulder pain and disability among active-duty members of the military and is associated with the development of glenoid osteochondral defects.

Purpose

To report clinical outcomes and survivorship after combined microfracture of isolated chondral lesions of the glenoid and labral repair among young, active-duty military patients and to compare outcomes with those of patients who underwent isolated shoulder stabilization.

Study Design

Cohort study; Level of evidence, 3.

Methods

Included were 31 active-duty military patients aged <40 years who underwent simultaneous microfracture of chondral lesions of the glenoid and labral repair for shoulder instability between January 2011 and January 2017 (microfracture group) and 209 patients without chondral defects who underwent shoulder stabilization during the same time period (instability group). Preoperative and 5-year postoperative outcomes (range of motion [ROM], visual analog scale [VAS] for pain, Single Assessment Numeric Evaluation [SANE] score, American Shoulder and Elbow Surgeons [ASES] shoulder score, and Rowe instability score) were compared within and between groups, and separate subgroup analyses were performed to determine whether variant of instability and dominant-shoulder involvement were associated with worse outcomes.

Results

The mean follow-up was significantly longer for the microfracture group versus the instability group (95.58 ± 23.12 vs 83.38 ± 25.93 months; P = .014). Age and sex distributions were similar between groups. In both groups, there was significant pre- to postoperative improvement on all outcomes scores (P = .0001 for all). When compared with the instability cohort, microfracture patients had significantly worse postoperative VAS pain (2.65 ± 1.78 vs 1.55 ± 1.92; P = .003), SANE (79.13 ± 14.43 vs 91.23 ± 13.20; P < .0001), and ASES (79.90 ± 13.87 vs 89.03 ± 14.28; P = .001) scores, as well as decreased ROM in forward flexion (151.29° ± 11.76° vs 155.48° ± 10.3°; P = .039) and external rotation (63.65° ± 8.34° vs 65.17° ± 0.64°; P = .010). At latest follow-up, 58% of microfracture patients had returned to active-duty military service compared with 93.78% of isolated instability patients (P < .0001).

Conclusion

Combined microfracture and arthroscopic labral repair produced modest, albeit statistically significant, improvements in patient-reported outcome measures and may be a reasonable treatment option for patients with chondral lesions who are not candidates for arthroplasty. However, microfracture patients had significantly worse outcomes than patients who underwent stabilization without concomitant chondral defects.