TY - JOUR
T1 - Beach Chair Versus Lateral Decubitus Position
T2 - Differences in Suture Anchor Position and Number During Arthroscopic Anterior Shoulder Stabilization
AU - MOON Shoulder Group
AU - Baron, Jacqueline E.
AU - Duchman, Kyle R.
AU - Hettrich, Carolyn M.
AU - Glass, Natalie A.
AU - Ortiz, Shannon F.
AU - Baumgarten, Keith M.
AU - Bishop, Julie Y.
AU - Bollier, Matthew J.
AU - Bravman, Jonathan T.
AU - Brophy, Robert H.
AU - Carpenter, James E.
AU - Cox, Charles L.
AU - Feeley, Brian T.
AU - Frank, Rachel M.
AU - Grant, John A.
AU - Jones, Grant L.
AU - Kuhn, John E.
AU - Lansdown, Drew A.
AU - Benjamin Ma, C.
AU - Marx, Robert G.
AU - McCarty, Eric C.
AU - Miller, Bruce S.
AU - Neviaser, Andres S.
AU - Seidl, Adam J.
AU - Smith, Matthew V.
AU - Wright, Rick W.
AU - Zhang, Alan L.
AU - Wolf, Brian R.
N1 - Publisher Copyright:
© 2021 The Author(s).
PY - 2021/7
Y1 - 2021/7
N2 - Background: Arthroscopic shoulder capsulolabral repair using glenoid-based suture anchor fixation provides consistently favorable outcomes for patients with anterior glenohumeral instability. To optimize outcomes, inferior anchor position, especially at the 6-o’clock position, has been emphasized. Proponents of both the beach-chair (BC) and lateral decubitus (LD) positions advocate that this anchor location can be consistently achieved in both positions. Hypothesis: Patient positioning would be associated with the surgeon-reported labral tear length, total number of anchors used, number of anchors in the inferior glenoid, and placement of an anchor at the 6-o’clock position. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study was a cross-sectional analysis of a prospective multicenter cohort of patients undergoing primary arthroscopic anterior capsulolabral repair. Patient positioning in the BC versus LD position was determined by the operating surgeon and was not randomized. At the time of operative intervention, surgeon-reported labral tear length, total anchor number, anchor number in the inferior glenoid, and anchor placement at the 6-o’clock position were evaluated between BC and LD cohorts. Descriptive statistics and between-group differences (continuous: t test [normal distributions], Wilcoxon rank sum test [nonnormal distributions], and chi-square test [categorical]) were assessed. Results: In total, 714 patients underwent arthroscopic anterior capsulolabral repair (BC vs LD, 406 [56.9%] vs 308 [43.1%]). The surgeon-reported labral tear length was greater for patients having surgery in the LD position (BC vs LD [mean ± SD], 123.5°± 49° vs 132.3°± 44°; P =.012). The LD position was associated with more anchors placed in the inferior glenoid and more frequent placement of anchors at the 6-o’clock (BC vs LD, 22.4% vs 51.6%; P <.001). The LD position was more frequently associated with utilization of ≥4 total anchors (BC vs LD, 33.5% vs 46.1%; P <.001). Conclusion: Surgeons utilizing the LD position for arthroscopic capsulolabral repair in patients with anterior shoulder instability more frequently placed anchors in the inferior glenoid and at the 6-o’clock position. Additionally, surgeon-reported labral tear length was longer when utilizing the LD position. These results suggest that patient positioning may influence the total number of anchors used, the number of anchors used in the inferior glenoid, and the frequency of anchor placement at the 6 o’clock position during arthroscopic capsulolabral repair for anterior shoulder instability. How these findings affect clinical outcomes warrants further study. Registration: NCT02075775 (ClinicalTrials.gov
AB - Background: Arthroscopic shoulder capsulolabral repair using glenoid-based suture anchor fixation provides consistently favorable outcomes for patients with anterior glenohumeral instability. To optimize outcomes, inferior anchor position, especially at the 6-o’clock position, has been emphasized. Proponents of both the beach-chair (BC) and lateral decubitus (LD) positions advocate that this anchor location can be consistently achieved in both positions. Hypothesis: Patient positioning would be associated with the surgeon-reported labral tear length, total number of anchors used, number of anchors in the inferior glenoid, and placement of an anchor at the 6-o’clock position. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study was a cross-sectional analysis of a prospective multicenter cohort of patients undergoing primary arthroscopic anterior capsulolabral repair. Patient positioning in the BC versus LD position was determined by the operating surgeon and was not randomized. At the time of operative intervention, surgeon-reported labral tear length, total anchor number, anchor number in the inferior glenoid, and anchor placement at the 6-o’clock position were evaluated between BC and LD cohorts. Descriptive statistics and between-group differences (continuous: t test [normal distributions], Wilcoxon rank sum test [nonnormal distributions], and chi-square test [categorical]) were assessed. Results: In total, 714 patients underwent arthroscopic anterior capsulolabral repair (BC vs LD, 406 [56.9%] vs 308 [43.1%]). The surgeon-reported labral tear length was greater for patients having surgery in the LD position (BC vs LD [mean ± SD], 123.5°± 49° vs 132.3°± 44°; P =.012). The LD position was associated with more anchors placed in the inferior glenoid and more frequent placement of anchors at the 6-o’clock (BC vs LD, 22.4% vs 51.6%; P <.001). The LD position was more frequently associated with utilization of ≥4 total anchors (BC vs LD, 33.5% vs 46.1%; P <.001). Conclusion: Surgeons utilizing the LD position for arthroscopic capsulolabral repair in patients with anterior shoulder instability more frequently placed anchors in the inferior glenoid and at the 6-o’clock position. Additionally, surgeon-reported labral tear length was longer when utilizing the LD position. These results suggest that patient positioning may influence the total number of anchors used, the number of anchors used in the inferior glenoid, and the frequency of anchor placement at the 6 o’clock position during arthroscopic capsulolabral repair for anterior shoulder instability. How these findings affect clinical outcomes warrants further study. Registration: NCT02075775 (ClinicalTrials.gov
KW - anterior
KW - arthroscopy
KW - beach-chair
KW - lateral decubitus
KW - shoulder instability
UR - http://www.scopus.com/inward/record.url?scp=85111422926&partnerID=8YFLogxK
U2 - 10.1177/03635465211013709
DO - 10.1177/03635465211013709
M3 - Article
C2 - 34019439
AN - SCOPUS:85111422926
SN - 0363-5465
VL - 49
SP - 2020
EP - 2026
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 8
ER -