Purpose
To analyze the available literature pertaining to clinical outcomes and complications
of posterior-inferior shoulder stabilization performed arthroscopically in either
the beach chair (BC) or lateral decubitus (LD) position.
Methods
According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA),
3 databases (PubMed, EMBASE, and Medline) were searched up to January 2018 for English-language
studies on posterior shoulder instability. Descriptive statistics are presented. The
Methodological Index for Non-Randomized Studies (MINORS) scale was used to assess
quality.
Results
Twenty-five studies were included, examining 1,085 patients (n = 140 BC; n = 945 LD),
of mean age 25.0 years, 27.1% female, and mean 3.1 years of follow-up. MINORS scores
for BC and LD were 11.2 and 9.8, respectively. Regardless of positioning, patients
did not differ across numerous outcomes and various surgical factors (e.g., number
of portals, anchors, anchor types, concomitant pathology, or postoperative rehabilitation
protocol). Postoperative patient satisfaction ranged from 85% to 87.5% and 93% to
100% for patients treated in BC and LD positions, respectively. Although not reported
for BC, overall and preinjury return-to-play (RTP) rates in LD patients ranged from
72% to 100% and 55% to 100%, respectively, returning from 3 to 7.6 months postoperatively.
Failure rates in the BC and LD positions ranged from 0% to 9.4% and 0% to 29%, respectively.
There were no differences in reported incidences of neuropraxia, stroke, nonfatal
pulmonary embolus, vision loss, cardiac arrest, or other positioning-related complications.
Conclusions
Arthroscopic management of posterior-inferior shoulder instability has a successful
track record and minimal complication profile. Although patient positioning appears
to influence results, with those treated in the LD position experiencing marginally
higher patient satisfaction and failure rates, the current data prevent any conclusions
being made regarding the superiority of one approach over another. As the clinical
relevance of patient positioning remains to be determined, larger, higher-level study
designs with long-term follow-up are required.
Level of Evidence
Level IV, systematic review of Level II, III, and IV studies.
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Article info
Publication history
Published online: November 16, 2018
Accepted:
June 19,
2018
Received:
March 27,
2018
Footnotes
See commentary on page 225
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2018 by the Arthroscopy Association of North America
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Access this article on ScienceDirectLinked Article
- Editorial Commentary: Beach Chair Versus Lateral Decubitus for Arthroscopic Posterior Shoulder Stabilization—Here We Go AgainArthroscopyVol. 35Issue 1
- PreviewRecent literature has suggested that patient positioning matters when it comes to arthroscopic anterior shoulder stabilization. Although advocates of the lateral decubitus position argue that only in this position can the anteroinferior and posteroinferior aspects of the glenoid be adequately visualized and instrumented, outcomes following posterior shoulder stabilization appear independent of patient position.
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