Title : Patient reported outcomes and return to sport testing 6 months after pediatric arthroscopic shoulder surgery
Abstract:
Background: Readiness for return to sport (RTS) after surgery can be assessed using strength and functional performance testing. Patient-reported outcomes measures (PROMs) may be useful in predicting success in RTS testing. However, data regarding RTS testing and PROMs 6 months after arthroscopic shoulder stabilization in adolescent and young adult patients is limited.
Purpose: The purpose of this study was to observe if the results of strength and functional RTS testing, and 6-month postoperative PROMs associate following arthroscopic stabilization in adolescent and young adult patients with shoulder instability.
Study Design: Retrospective review
Methods: The medical records of adolescent and young adult patients who underwent arthroscopic shoulder stabilization at a single orthopedic surgery department and subsequent RTS testing at the institution’s sports rehabilitation clinic between 2017 and 2024 were reviewed.
Patient demographics, operative details, patient-reported outcome measures (PROMs) (Tegner, ASES, QuickDASH), and RTS testing results were collected. PROMs were obtained at the time of the RTS test. The recovery of muscle strength was defined by a limb symmetry index (LSI) ≥90% and considered a pass. The study examined RTS testing results and PROMs in pass and fail groups, and P-values were determined using Wilcoxon rank sum test. After identifying significant variables in the bivariate analysis, we ran multivariate regression adjusting for age and BMI, and predicted means with P- and model F-values were reported for these tests.
Results: A total of 59 patients were included (64.4% male, mean age 16.1, mean body mass index 25.58). 66.1% of patients underwent surgery on their dominant shoulder. RTS testing was performed at a mean of 6.36 months postoperatively. 98.3% of patients were cleared to RTS at a mean of 6.07 months post operatively. Between pass and fail groups, differences in pain, ASES, and QuickDash scores were identified in upper extremity Y-balance tests (UE Y-bal-comp), dynametric external rotation (ER) tests, and dynametric internal rotation (IR) tests. Between pass and fails groups in UE Y-bal-comp, post-operative ASES scores were higher among pass groups (p=0.005). Similarly, post-operative pain and QuickDash scores decreased in UE Y-bal-comp pass groups (p=0.0449 and p=0.0441, respectively). Post-operative QuickDash scores decreased in the grip strength testing pass group (p=0.0095). ASES score increased in dynametric ER testing pass groups (p=0.0438). QuickDash decreased in dynametric IR testing pass groups (p=0.009). In the multivariate analysis adjusted for age and BMI, the average difference in 6- month ASES between the UE Y-bal-comp pass and fail groups was 9.45 (P = 0.0021, F = 0.0125). The average difference in 6-month QuickDash between the grip strength pass and fail groups was -7.08 (P = 0.002, F = 0.0131).
Conclusion: Shoulder strength and stability deficits persisted in the surgical limb of adolescent and young adult patients up to 6 months after arthroscopic stabilization, and in certain tests
PROMs were associated with pass and fail. Postoperative QuickDash, ASES, and pain scores were found to be associated with objective shoulder strength and stability measurements.
What will audience learn from your presentation?
- At 6 months postoperative, functional deficits may be resolved while strength deficits may persist, and PROMs improve significantly following shoulder stabilization surgery. With the current timeframe and RTS protocols in adolescent and young adult patients following arthroscopic shoulder surgery, a large portion of patients will fail some aspect of the RTS testing at the expected readiness date. PROMs may have utility in predicting outcomes of RTS testing.
- Providers may utilize PROMs to associate with specific components of RTS pass or fail outcomes in patients following arthroscopic stabilization in adolescent and young adult patients with shoulder instability.
- By using subjective measures, the surgeon may predict objective findings at 6 months postoperatively.
- Surgeons may use similar research methods in their patient populations to improve generalizability, as well as apply subjective measures from their patients to their own RTS protocols to predict outcomes. One possible route of expansion may be to collect PROMs in the preoperative period and perform analyses on subjective and objective data in the follow up period to associate preoperative PROMs with postoperative outcomes.
