Surgical Treatment of Traumatic Anterior Shoulder Instability in American Football Players

Background: American football players have been reported to be at high risk for postoperative instability after arthroscopic stabilization of anterior shoulder instability. While some authors have recommended open methods of stabilization in athletes who play contact sports, there are few data in the literature showing more favorable results with use of an open technique. We reviewed the results of an open technique of anterior shoulder stabilization in fifty-eight American football players after a minimum of two years of follow-up. Methods: Fifty-eight American football players underwent open stabilization with use of a standardized technique for the treatment of recurrent anterior shoulder instability. Forty-seven patients had recurrent dislocations, and the remaining eleven had recurrent subluxations. The average age of the patients was 18.2 years, and the average duration of follow-up was thirty-seven months. Patients were evaluated according to the shoulder scoring system of the American Shoulder and Elbow Surgeons and with use of the shoulder instability score described by Rowe and Zarins. Results: There were no postoperative dislocations. Postoperative subluxation occurred in two patients, neither of whom had had a dislocation prior to the operation. Forward flexion and external rotation returned to within 5° of those of the contralateral shoulder in forty-nine patients. The average score according to the system of the American Shoulder and Elbow Surgeons was 97.0 points, and the average Rowe and Zarins score was 93.6 points. Fifty-five patients had a good or excellent result, and fifty-two of the fifty-eight returned to playing football for at least one year. One patient was forced to stop playing because of recurrent instability. Conclusions: Open stabilization is a predictable method of restoring shoulder stability in American football players while maintaining a range of motion approximating that found after arthroscopic stabilization. Postoperative stability appears to be superior to that reported after arthroscopic techniques in this population of patients.