Journal of Pediatric Orthopaedics - 2026-04-01 - Journal Article
Arthroscopic Stabilization of Shoulder Instability in Children and Adolescents With Open Physes: Minimum Two-year Follow-up Portends Unsatisfactory Recurrence Rates.
Walls HR, Chung PJ, Grewal RS, Dexter MJ, Bryan TP, Edmonds EW, Schlechter JA, Pennock AT
Topics
Key Takeaway
Arthroscopic shoulder stabilization in skeletally immature patients yields a 34.7% recurrence rate and 10% revision rate at mean 5.1-year follow-up, with younger age as the primary risk factor.
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Summary
This two-center retrospective study evaluated arthroscopic shoulder stabilization outcomes in 101 skeletally immature patients (mean age 14.8 years) with minimum 2-year follow-up. At mean 5.1 years, 34.7% experienced recurrent instability and 10% required revision surgery, with mean PASS score of 88±14. Younger age at surgery was the only significant predictor of recurrence; sex, instability direction, pre-operative dislocation count, and contact sport participation were not.
Key Limitation
Absence of preoperative and postoperative glenoid and humeral head bone loss quantification prevents determination of whether bony deficiency—not skeletal immaturity per se—drives the elevated recurrence rate.
Original Abstract
BACKGROUND
Outcomes following shoulder instability events suggest high rates of recurrence for the pediatric population. Previous studies have not focused on those with open physes at the proximal humerus, and longer-term surgical outcomes have not been evaluated for this population. The purpose of the current study is to evaluate patient-reported outcomes and recurrence rates in skeletally immature children and adolescents undergoing arthroscopic stabilization procedures.
METHODS
A retrospective review of all skeletally immature patients who underwent arthroscopic shoulder stabilization between 2009 and 2021 from 2 pediatric hospitals was performed. Demographic, injury, imaging, and intraoperative data were recorded. Patient-reported outcomes, including the Pediatric/Adolescent Shoulder Survey (PASS), return to sport, instability recurrence, and need for revision surgery, were documented. Statistical analysis was performed to assess risk factors for recurrence.
RESULTS
One hundred one skeletally immature patients met the inclusion criteria. The mean age at the time of surgery was 14.8 ± 1.4 years, and 74% were males. The majority of patients had anterior instability (78%), 17% had posterior instability, and 5% had multidirectional instability. Contact sports were responsible for 47% of injuries. The average number of dislocations before surgery was 2.6 ± 3.4. At a mean follow-up of 5.1 ± 2.9 years, the mean PASS score was 88 ± 14. A total of 35 patients (34.7%) experienced recurrent instability, and 10 patients (10%) had a revision procedure. Patients with recurrent instability were found to be younger, had longer clinical follow-up duration, and had a lower final PASS score. Direction of instability was not associated with recurrence rate. Other factors such as sex, number of dislocations before surgical intervention, and participation in contact sports were not significantly associated with recurrent instability.
CONCLUSIONS
While the majority of skeletally immature children and adolescents undergoing arthroscopic shoulder stabilization can achieve favorable outcomes, recurrent instability remains a problem, as ∼1 in 3 patients may experience recurrent instability with younger patients being at particular risk.
LEVEL OF EVIDENCE
Level IV-retrospective case series prognostic study.