Poster 32: Arthroscopic All-Suture Anchor Posterior Labral Repair Outcomes in American Football Athletes

Objectives: Posterior glenoid labrum injuries are up to 15 times more common in American football athletes than the general population. Linebackers and linemen in particular are at increased risk due to the acute trauma and/or repetitive microtraumas on adducted, internally rotated shoulder positions associated with blocking and block-shedding activities inherent to their position groups. While recent literature has supported the advancement from open repairs to arthroscopic anatomic glenoid labral repairs, most data on patient-reported outcomes (PRO) and return-to-sport (RTS) rates come from studies evaluating repairs using traditional hard body anchors such as metal, biocomposite, or polyetheretherketone (PEEK). More recently, all-suture soft anchors were developed with intentionally minimalist constructs that permit placement of more fixation points on the glenoid surface with decreased bone and soft tissue damage upon anchor placement relative to traditional anchor materials, while also demonstrating comparable biomechanical properties. For a population at high risk for re-injury, the bone-preserving profile and ease of repeat imaging without significant implant artifact makes the use of all-suture anchors appealing. Despite encouraging recent reports of outcomes following all-suture anchor anterior labral repair, to our knowledge, there are no clinical studies investigating outcomes for posterior glenoid labral repair in football athletes. The purpose of this study was to evaluate patient-reported function and RTS outcomes following arthroscopic posterior glenoid labral repairs using all-suture anchors in American football athletes. Methods: We identified all patients in our institution’s ongoing outcomes data repository that were American football players of all ages and levels of competition when they underwent arthroscopic posterior glenoid labral repair using all-suture anchors. Patients were excluded if they: 1) underwent an open labral repair procedure; 2) underwent arthroscopic labral repair with any hard anchor; 3) underwent concomitant rotator cuff repair or any bone/tendon transfer procedures alongside labral repair; or 4) had glenohumeral osteoarthritis identified intraoperatively. Patients with concomitant biceps tenodesis and those with labral repair in locations in addition to the posterior labrum were included. We collected baseline (pre-surgical) and follow-up patient-reported demographic, athletic, surgical, and functional outcomes data, with a minimum follow-up time of 2 years. Patient-reported functional outcome measures included the American Shoulder and Elbow Surgery Score (ASES) and the Western Ontario Shoulder Instability Index Score (WOSI) as well as a series of questions regarding RTS. We compared baseline and follow-up ASES and WOSI scores across the entire cohort. We also compared follow-up ASES and WOSI scores between those that underwent combined Bankart and posterior labral repairs with posterior labral repair only, between athletes in blocking and non-blocking positions, and lastly between collegiate and high school athletes. Results: Fifty-two male football athletes (mean age at surgery=18.5 years) were included with both pre-surgical and follow-up outcomes data (mean follow-up time=3.8 years), with all competing at either the high school (n=41, 79%) or collegiate (n=11, 21%) level (Table 1). Linemen and linebackers were the most represented position groups. Mean values of ASES and WOSI scores improved from baseline to follow-up to a statistically-significant and clinically-important extent (Table 2). There were no differences in follow-up ASES or WOSI scores between high school and collegiate athletes, between blocking and non-blocking position groups, nor between isolated posterior labral repair and combined posterior labral/Bankart repair. Among athletes that attempted to RTS, 97% (37/38) were able to return to football at their preinjury level following surgery. Only 1 player that attempted to RTS was unable to due to post-operative limitations from the shoulder. No athletes underwent revision surgeries in this cohort, either at our institution or at outside institutions. Conclusions: Our results demonstrated excellent outcomes, including large and significant improvements in ASES and WOSI scores, a high level of return to preinjury level of sport, and no subsequent revision surgeries in American football players following all-suture anchor posterior labral repair. These findings support the use of all-suture anchors as a low-profile, tissue-preserving alternative to traditional hard anchors for posterior labral repairs in this population of athletes at high risk of injury and re-injury.

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