Good afternoon, I appreciate the invitation to come speak here at this annual meeting and definitely want to thank all of my co-authors, definitely two talks that are difficult to follow. We have no disclosures. So anterior instability is the most common type of shoulder instability that we see. When we're treating these injuries, there's been an increase in popularity in arthroscopic versus open stabilization procedures performed with varying rates of recurrence. There's been multiple studies out there that look at, that identify patient injury specific characteristics that are at higher risk for recurrent instability, that'd be decreased age, increased activity level, involvement in contact and overhead sports, as well as surgical factors such as implant quantity, surgical technique. However, there have not been any studies that have directly examined the association between the beach chair position versus lateral decubitus position and the clinical outcomes of recurrent instability. Therefore, the purpose of our study was twofold. It was to compare the rates of recurrent instability recurrence after arthroscopic anterior stabilization performed in the beach chair versus lateral decubitus position in a high demand patient population at midterm follow-up. Additionally, we sought to identify potential risk factors associated with recurrence and revision surgery in this population. This is a retrospective analysis of 641 shoulders that underwent an index arthroscopic bank heart repair. We defined short-term follow-up as one year, midterm follow-up as five years. We included patients that underwent an index surgery for isolated anterior instability. All patients had preoperative MRIs available for evaluation. All surgeons were fellowship trained, sports medicine fellowship trained. And all patients had a minimum of one year follow-up. The data was analyzed for data on recurrence and revision surgery, as well as other operative variables. We defined recurrence as the presence of recurrent subluxation or dislocation event. And we defined revision as a secondary surgery specifically done to address the instability recurrence. Additionally, we evaluated all preoperative MRIs for the assessment of linoid bone loss and separated those into the three groups listed below. So in assessing the overall characteristics of the overall cohort, there's a statistically significant difference in age between the two groups. It was small, but statistically significant. 22.4 years of age in the beach chair group, 21.8 in the lateral decubitus group. There was no difference amongst the two positions regarding sex or linoid bone loss. Most importantly here, in the overall cohort, there was no difference in the recurrence rates amongst the two groups. And overall, there was a recurrence rate of 15.8 percent. We further break down that total cohort, those that had one year and five year follow-up. There was, again, no difference in recurrence rates between the two groups at both time periods. And the overall recurrence rate at mid-term follow-up at five years was 15.7 percent. So moving on to the second purpose of our study. We assessed multiple variables for the potential risk factors for progression to revision surgery or recurrence using a multivariable model. And at one year, there were no variables that predicted recurrence or revision surgery. Using the same multivariable modeling techniques, we looked at the five-year time point, and only younger age was associated with recurrence and revision surgery. The only study currently in the literature that compares clinical outcomes of beach chair versus lateral decubitus head-to-head is a well-done study referenced earlier by Dr. Frank et al. It was 64 studies, and they suggested that lateral decubitus may have lower recurrence rates, but both may produce good outcomes. Some take-home points from the study. There was variable follow-up amongst the two groups. Beach chair had a year more of follow-up, potentially another extra year to potentially fail as four years versus three for lateral decubitus. Unknown training status of the surgeons in regards to fellowship training. Variable definitions of recurrence amongst all the studies, and they did not evaluate for glenoid bone loss. In the present study, we found no difference in recurrence rates amongst beach chair versus lateral decubitus positioning for arthroscopic anterior stabilization surgery. The overall position was not found to be a risk factor associated with recurrence at short and mid-term follow-up, and there was no difference in recurrence rates when stratified by glenoid bone loss. Lastly, overall, we reported an overall occurrence rate at five years of 15.7% in this uniquely high-risk population. So our conclusion was that among fellowship-trained orthopedic surgeons, there was no difference in rates of recurrent instability after positioning, after performing arthroscopic stabilization for isolated anterior shoulder instability in a high-demand population in either the beach chair or lateral decubitus position. Additionally, in a multivariable analysis, younger age but not surgical position was an independent risk factor for recurrence. Thank you.

arthroscopic shoulder stabilization

beach chair position

lateral decubitus position

recurrent instability

shoulder surgery