Background: Little is known about the risk factors for glenohumeral joint instability. We hypothesized that a prior history of instability would be a significant risk factor for subsequent injury. Methods: We conducted a prospective cohort study over a four-year period within a high-risk group of young athletes to address the research hypothesis. Subjects were freshmen entering the U.S. Military Academy in June of 2006. Part of the baseline assessment included documenting a prior history of glenohumeral instability on entry into the study. All subjects were followed for subsequent glenohumeral joint instability events until graduation in May of 2010. The primary outcome of interest in this study was time to glenohumeral instability event during the follow-up period. We examined injury outcomes, looking for any instability, anterior instability, and posterior instability events. Cox proportional-hazards regression models were used to analyze the data. Results: Among the 714 subjects, eight shoulders were excluded from the analyses due to prior surgical stabilization, leaving 1420 shoulders, of which 126 had a self-reported prior history of instability. There were forty-six (thirty-nine anterior and seven posterior) acute instability events documented in the cohort during the follow-up period. Subjects with a prior history of instability were over five times (p < 0.001) more likely to sustain an acute (anterior or posterior) instability event during the follow-up period. Subjects with a history of instability were also 5.6 times (p < 0.001) more likely to experience a subsequent anterior instability event and 4.6 times (p = 0.068) more likely to experience a posterior instability event during follow-up. Similar results were observed in multivariable models after controlling for the influence of demographic and baseline physical examination findings. Conclusions: Despite meeting the rigorous physical induction standards for military service, subjects with a prior history of glenohumeral joint instability were approximately five times more likely to experience a subsequent instability event, regardless of direction, within this high-risk athletic population. Level of Evidence: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
Bibliographical noteFunding Information:
N ote : This project was aided by a grant from the Orthopaedic Research and Education Foundation. A study of this scope and nature would not be possible without the support and assistance of many colleagues. The authors thank Tim Kelly, ATC, and Dana Putnam, ATC, in the Department of Intercollegiate Athletics at the United States Military Academy (USMA); Dr. Craig Yunker, ATC, Karen Peck, ATC, Chris Jones, ATC, and Jason Suby, ATC, in the Department of Physical Education at the USMA; and Colonel Paul Stoneman, PT, PhD, Major William Loro, DPT, Major Mark Thelen, DPT, Lieutenant Colonel James Dauber, DPT, and Major Heath Todd, DPT, in the Keller Army Hospital Physical Therapy Department for their assistance with the logistics, baseline data collection, and injury surveillance for this project. The authors also recognize and thank the members of the USMA Graduating Class of 2010 for their participation in this study and their commitment to serve our nation.
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