CORR Insights®: Recurrent Instability and Surgery Are Common After Nonoperative Treatment of Posterior Glenohumeral Instability in NCAA Division I FBS Football Players.

Posterior shoulder instability tends to be the result of repetitive microtrauma [14]. Posterior shoulder instability only accounts for up to 10% of all instances of shoulder instability [10], but it may be more common in young military cadets [3, 10] and National Football League (NFL) combine participants than in the general population. Among NFL combine participants, MR images of 38% of players showed evidence of posterior labral tears [8]. Posterior shoulder instability and its associated pathologies are reported most frequently in weightlifters, football linemen, rugby players, swimmers, gymnasts, wrestlers, overhead athletes, and active-duty military service members. Patients with posterior shoulder instability may be treated with or without surgery. Nonoperative management is aimed at controlling pain and increasing stability, and these goals might be attained through a three-phase program: (1) static proprioceptive control through closed-chain kinetic movements with visual feedback; (2) dynamization through isokinetic balancing of the internal and external rotators to ultimately accomplish global concentric strengthening; and (3) dynamic, proprioceptive, open-chain, kinetic exercises for eventual return to sports [5]. There have been no comparative studies with different protocols to examine posterior shoulder instability, but this seems logical and comparable to the protocols examining anterior shoulder instability. After undergoing nonoperative care, as many as 70% of patients with posterior shoulder instability eventually undergo surgery [16]. Risk factors for undergoing surgery include BMI greater than 35 kg/m and contact or weightlifting athletes [16]. It has also been demonstrated that patients with evidence of a posterior labral tear on MRI who simultaneously had subjective complaints and objective examination results consistent with instability and those with increased glenoid retroversion and posterior humeral head subluxation were more likely to undergo surgery than patients without these factors [4]. For patients without substantial bone loss whose symptoms do not improve with nonoperative treatment, arthroscopic posterior capsulolabral repair is, in my experience, the most-commonly used approach, with operatively treated patients reporting high return to activity, low risk of recurrence [3], and clinically important improvements in patientreported outcomes (for example, American Shoulder and Elbow Surgeons, Rowe, Walch-Duplay, Constant, and Single Assessment Numeric Evaluation scores) [6, 7]. Regardless, many athletes—particularly overhead athletes—do not return to previous levels of play [6], and some undergo revision surgery. Factors associated with these problems include the use of anchorless techniques, use of fewer than four anchors, being a This CORR Insights is a commentary on the article “Recurrent Instability and Surgery Are Common After Nonoperative Treatment of Posterior Glenohumeral Instability in NCAA Division I FBS Football Players” by Tennent et al. available at: DOI: 10.1097/CORR. 0000000000001471. The author certifies that neither he, nor any members of his immediate family, have funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. B. M. Bodendorfer ✉, Midwest Orthopaedics at Rush, 1611 W. Harrison St. Chicago, IL 60612 USA, Email: blakebodendorfer@gmail.com B. M. Bodendorfer, Midwest Orthopaedics at Rush, Chicago, IL, USA