title: History of shoulder instability and subsequent injury during four years of follow-up: a survival analysis.
abstract: 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.
authors: Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, West Point, NY 10996, USA. kenneth.cameron@amedd.army.mil
authors: Kenneth L
authors: KL
authors: Cameron
authors: Sally B
authors: SB
authors: Mountcastle
authors: Bradley J
authors: BJ
authors: Nelson
authors: Thomas M
authors: TM
authors: DeBerardino
authors: Michele L
authors: ML
authors: Duffey
authors: Steven J
authors: SJ
authors: Svoboda
authors: Brett D
authors: BD
authors: Owens
mesh_terms: D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000209:etiology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008889:Military Personnel; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D057566:Self Report; D012783:Shoulder Dislocation / Q000209:etiology*; D014481:United States; D055815:Young Adult