Sex-Based Differences in Clinical Outcomes After Arthroscopic Anterior Shoulder Stabilization: Results at 5-Year Follow-up

Mo Chen; Sijia Feng; Yuzhou Chen; Zheci Ding; Yuxue Xie; Jiwu Chen; Yinghui Hua; Jun Chen; Jianjun Yang; Shiyi Chen

doi:10.1177/23259671211008841

Sex-Based Differences in Clinical Outcomes After Arthroscopic Anterior Shoulder Stabilization: Results at 5-Year Follow-up

Orthop J Sports Med. 2021 May 20;9(5):23259671211008841. doi: 10.1177/23259671211008841. eCollection 2021 May.

Authors

Mo Chen¹, Sijia Feng¹, Yuzhou Chen¹, Zheci Ding¹, Yuxue Xie², Jiwu Chen¹, Yinghui Hua¹, Jun Chen¹, Jianjun Yang³, Shiyi Chen¹

Affiliations

¹ Sports Medicine Institute, Department of Sports Medicine and Arthroscopy, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
² Department of Radiology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
³ Department of Orthopaedics, Tenth People's Hospital of Tongji University, Shanghai, People's Republic of China.

Abstract

Background: The influence of patient sex on clinical outcomes after arthroscopic anterior shoulder stabilization is unclear.

Purpose: To investigate sex-based differences in clinical outcomes after arthroscopic anterior shoulder stabilization.

Study design: Cohort study; Level of evidence, 3.

Methods: A retrospective study was conducted among 76 patients who underwent arthroscopic anterior shoulder stabilization from February 2010 to December 2017. The patients were grouped by sex. The recurrence rate of instability was compared, as were pre- and postoperative pain scores, functional outcome scores, and active range of motion (ROM). Postoperative magnetic resonance imaging (MRI) was also performed for structural assessment of the glenohumeral joint.

Results: No significant difference was found in the recurrence rate between female and male patients (13.3% vs 14.8%; P ≥ .999; risk ratio, 1.107 [95% CI, 0.266-4.597]). Compared with male patients, female patients had a significantly lower preoperative Constant score (94.4 ± 6.4 vs 85.4 ± 11.1; P = .002), forward flexion (173.8° ± 10.7° vs 154.0° ± 33.8°; P = .011), abduction (171.0° ± 18.4° vs 142.7° ± 39.9°; P = .001), and external rotation (76.6° ± 21.6° vs 67.7° ± 20.4°; P = .037). Postoperatively, female patients had a significantly lower Simple Shoulder Test score compared with men (8.8 ± 1.9 vs 10.3 ± 1.6; P = .005). The mean changes from pre- to postoperative Rowe score (43.6 ± 21.4 vs 31.5 ± 19.8; P = .044), Constant score (9.9 ± 8.9 vs 0.8 ± 8.1; P = .002), forward flexion (24.0 ± 36.2 vs 4.2 ± 10.9; P = .013), abduction (36.0 ± 38.3 vs 7.6 ± 18.4; P < .001), and external rotation (19.7 ± 21.3 vs 6.7 ± 26.2; P = .023) in female patients were significantly higher than those in the men. There were no sex-based differences on any MRI parameter measured.

Conclusion: Female patients had a similar recurrence rate as that of male patients after arthroscopic anterior shoulder stabilization. Most postoperative clinical outcome measures showed no significant difference between the sexes. Despite worse preoperative values, more significant improvements in postoperative shoulder function and active ROM were seen in women.

Keywords: anterior shoulder instability; arthroscopic shoulder stabilization; clinical outcome; recurrence; sex.