Flint James H, Pickett Adam, Owens Brett D, Svoboda Steven J, Peck Karen Y, Cameron Kenneth L, Biery John, Giuliani Jeffrey, Rue John-Paul
Sports Health. 2018 Jan/Feb;10(1):54-59. doi: 10.1177/1941738117707177. Epub 2017 May 11.
Shoulder instability is a topic of significant interest within the sports medicine literature, particularly regarding recurrence rates and the ideal treatment indications and techniques. Little has been published specifically addressing the occupational implications of symptomatic recurrent shoulder instability.
Previous arthroscopic repair will continue to be a significant predisposing factor for recurrent instability in a young, active population, and that recurrent instability may have a negative effect on college graduation and postgraduate occupational selection.
Case series.
Level 4.
We conducted a retrospective review of approved medical waivers for surgical treatment of anterior shoulder dislocation or instability prior to matriculation at the US Military Academy or the US Naval Academy for the graduating classes of 2010 to 2013. Statistical analysis was performed to determine the incidence and risk factors for recurrence and to determine the impact on graduation rate and occupation selection.
Fifty-nine patients were evaluated; 34% developed recurrent anterior instability. Patients with previous arthroscopic repair had a significantly higher incidence of recurrence (38%, P = 0.044). Recurrent shoulder instability did not significantly affect graduation rates or self-selected occupation ( P ≥ 0.05).
There is a significant rate of recurrent shoulder instability after primary surgical repair, particularly among young, active individuals. In addition, arthroscopic repair resulted in a significantly higher recurrence rate compared with open repair in our population. Surgical repair for shoulder instability should not necessarily preclude young individuals from pursuing (or being considered for) occupations that may place them at greater risk of recurrence.
The risk of recurrent instability is greater than the rate typically described, which may suggest that some subpopulations are at greater risk than others. A unique data point regarding instability is the effect on occupation selection.
肩部不稳定是运动医学文献中备受关注的话题，尤其是在复发率以及理想的治疗指征和技术方面。关于有症状的复发性肩部不稳定对职业的影响，专门发表的内容较少。
既往关节镜修复术仍将是年轻、活跃人群复发性不稳定的重要诱发因素，且复发性不稳定可能对大学毕业和研究生职业选择产生负面影响。
病例系列研究。
4级。
我们对2010年至2013年毕业于美国军事学院或美国海军学院的学生在入学前接受肩部前脱位或不稳定手术治疗的批准医疗豁免进行了回顾性研究。进行统计分析以确定复发的发生率和危险因素，并确定其对毕业率和职业选择的影响。
共评估了59例患者；34%出现复发性前不稳定。既往接受关节镜修复术的患者复发率显著更高（38%，P = 0.044）。复发性肩部不稳定对毕业率或自我选择的职业没有显著影响（P≥0.05）。
初次手术修复后肩部复发性不稳定的发生率较高，尤其是在年轻、活跃的个体中。此外，在我们的研究人群中，关节镜修复术的复发率明显高于开放修复术。肩部不稳定的手术修复不一定会妨碍年轻人从事（或被考虑从事）可能使他们复发风险更高的职业。
复发性不稳定的风险高于通常描述的发生率，这可能表明某些亚群的风险高于其他亚群。关于不稳定的一个独特数据点是其对职业选择的影响。
