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Scientific Articles   |    
History of Shoulder Instability and Subsequent Injury During Four Years of Follow-upA Survival Analysis
Kenneth L. Cameron, PhD, MPH, ATC1; Sally B. Mountcastle, PhD1; Bradley J. Nelson, MD2; Colonel (Ret) Thomas M. DeBerardino, MD3; Michele L. Duffey, MS4; Lieutenant Colonel Steven J. Svoboda, MD1; Lieutenant Colonel Brett D. Owens, MD1
1 Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, 900 Washington Road, West Point, NY 10996. E-mail address for K.L. Cameron: kenneth.cameron@amedd.army.mil
2 Sports Medicine & Shoulder Division, Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55454
3 Department of Orthopaedic Surgery, University of Connecticut Health Center, MARB4, 263 Farmington Avenue, Farmington, CT 06030
4 Department of Kinesiology, Pennsylvania State University, 271F Recreation Building, University Park, PA 16803
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  • Disclosure statement for author(s): PDF

Investigation performed at the Department of Orthopedic Surgery, Keller Army Hospital, West Point, New York, the Sports Medicine & Shoulder Division, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, the Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, and the Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania

Disclaimer: The views and opinions expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the United States Government.



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Mar 06;95(5):439-445. doi: 10.2106/JBJS.L.00252
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Abstract

Background: 

Little is known about the risk factors for glenohumeral joint instability. We hypothesized that a prior history of instability would be a significant risk factor for subsequent injury.

Methods: 

We conducted a prospective cohort study over a four-year period within a high-risk group of young athletes to address the research hypothesis. Subjects were freshmen entering the U.S. Military Academy in June of 2006. Part of the baseline assessment included documenting a prior history of glenohumeral instability on entry into the study. All subjects were followed for subsequent glenohumeral joint instability events until graduation in May of 2010. The primary outcome of interest in this study was time to glenohumeral instability event during the follow-up period. We examined injury outcomes, looking for any instability, anterior instability, and posterior instability events. Cox proportional-hazards regression models were used to analyze the data.

Results: 

Among the 714 subjects, eight shoulders were excluded from the analyses due to prior surgical stabilization, leaving 1420 shoulders, of which 126 had a self-reported prior history of instability. There were forty-six (thirty-nine anterior and seven posterior) acute instability events documented in the cohort during the follow-up period. Subjects with a prior history of instability were over five times (p < 0.001) more likely to sustain an acute (anterior or posterior) instability event during the follow-up period. Subjects with a history of instability were also 5.6 times (p < 0.001) more likely to experience a subsequent anterior instability event and 4.6 times (p = 0.068) more likely to experience a posterior instability event during follow-up. Similar results were observed in multivariable models after controlling for the influence of demographic and baseline physical examination findings.

Conclusions: 

Despite meeting the rigorous physical induction standards for military service, subjects with a prior history of glenohumeral joint instability were approximately five times more likely to experience a subsequent instability event, regardless of direction, within this high-risk athletic population.

Level of Evidence: 

Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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