Do modern orthopaedic trainees have sufficient exposure to open shoulder stabilization procedures?

Background: Arthroscopic stabilization and bone augmentation procedures have become common treatment options for anterior shoulder instability, while the use of open soft tissue stabilization procedures has declined. This study aimed to determine current trends in utilization of open soft tissue stabilization among shoulder surgeons and the relationship between procedure volume in practice and exposure as trainees. Methods: Out of the 1,115 American Shoulder and Elbow Surgeon members surveyed, 212 surgeons completed a questionnaire about exposure to open soft tissue stabilization techniques during training, practice patterns for shoulder instability, perceived skill with open soft tissue stabilization procedures, and opinions on the importance of these procedures. Statistical analyses correlated practice numbers, training exposure, and self-perceived facileness. Results: Out of the 212 surgeons who completed the survey, 71% (n=153/212) of respondents performed less than 25% of their stabilization procedures in an open manner. Sixty-seven percent (n=143/212) of respondents reported that less than 10% of their open procedures involved only soft tissue. The number of open soft tissue stabilization procedures performed in practice correlated with the number performed during residency (r=0.42; P<0.001) and fellowship (r=0.46; P<0.001). Eighty percent of respondents reported self-perceived facileness with open soft tissue stabilization which correlated with the number of procedures performed in practice (P<0.001), residency (P<0.001), and fellowship (P<0.001). Half of respondents (51%; n=109/212) believed that procedure exposure was necessary for residents. Conclusion: Shoulder specialists perform a low volume of open soft tissue stabilization procedures currently. Exposure throughout training correlates with using these procedures in practice, and with surgeon confidence.