Pathology and surgical outcomes of anterior traumatic shoulder instability in gymnasts (235)

OBJECTIVES: For shoulders of artistic gymnasts, stability against various forces such as weight bearing, torsion, and traction is required as well as wide range of motion. The prevalence of shoulder instability in gymnasts has been reported to be high, particularly in female gymnasts; however, there has been no report on its pathology and the surgical outcomes. The purpose of this study was to retrospectively investigate the pathology and surgical outcomes of anterior traumatic shoulder instability in gymnasts. METHODS: The subjects of this study were 18 shoulders of 16 gymnasts that underwent arthroscopic surgery for anterior traumatic shoulder instability. They consisted of 4 male and 14 female shoulders with a mean age of 18 years (range, 16-20). The mean follow-up was 30 months (range, 10-66 months). All surgeries were performed arthroscopically, and procedures were determined according to the intraoperative findings. Patients were immobilized with a brace for 3 weeks and started range of motion exercise after the immobilization period. Hand-stand or hanging were normally allowed at 3 month after surgery according to patients’ functional recovery. We investigated injury mechanism, intraoperative findings, surgical procedures, times to start hand-stand or hanging and to start giant swing, time to complete return to gymnastics, and recurrence of instability. RESULTS: Three shoulders experienced dislocations that self-reduction was impossible. The remaining 15 shoulders had self-reducible dislocations or subluxations, and 10 of 15 shoulders were injured with the shoulder hyper-flexed: e.g., pulling up hands during somersaults; pushing off the vault (Figure). Bankart lesion was identified during surgery in 14 shoulders including one bony Bankart lesion. Capsular tear was found in 5 shoulders, and only one lesion was concomitant with Bankart lesion. All lesions were arthroscopically repaired. We additionally performed rotator interval closure in 10 shoulders, superior labrum repair in 13, and rotator cuff repair in 2. One patient retired from gymnastics immediately after surgery, and 2 patients were lost to follow-up. The remaining 13 patients returned to gymnastics. The mean time to start hand-stand or hanging was 4 months (range, 3-10 months), and that to start giant swing was 6 months (range, 3-15 months). The mean time to complete return was 9 months (range, 5-17 months). Two shoulders experienced recurrence (1 dislocation and 1 subluxation) after return to gymnastics. Both shoulders underwent revision surgery and returned to gymnastics. CONCLUSIONS: Capsular tear without Bankart lesion was more common (4 shoulder, 22%) in gymnasts than general population. The sport-related characteristics might be associated with the high incidence of capsular tear. The outcomes of arthroscopic stabilization for gymnasts was good with the high complete return rate.