Association between Baseline PROMS and Incident Glenohumeral Joint Instability- SOMOS 2025
k cameron, m aderman, m donohue, s gee, m bradley, r robins, l leclere, r waltz, m slabaugh, t dekker, j dickens
Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.
INTRODUCTION: The incidence rates for glenohumeral joint instability injuries in military service members and service academy cadets has been reported to be up to 20 times higher when compared to the general population. These injuries often require surgical intervention and stabilization and they can limit function and the ability to complete mission essential tasks. As a result, these injuries have a significant impact on military and medical readiness. Despite the significant impact these injuries have, we currently have limited capacity to screen for injury risk. The purpose of this study was to examine the association between patient reported outcome measures (PROM) collected at the time of accession and time to sustaining a subsequent glenohumeral joint instability event during follow-up.
METHODS: A part of a multicenter prospective cohort study, this preliminary analysis was conducted among incoming cadets at a single United States Military Service Academy with enrollment between August 2020 and August 2022. Demographic information, including sex, health history, history of shoulder instability injuries, history of surgery for shoulder instability, and sports participation history were collected at the time of enrollment, within the first 6 weeks of accession. General (PROMIS Physical Function and Brief Resilience Scale) and shoulder specific (ASES and SANE) PROMs were collected bilaterally at the time of enrollment. Active injury surveillance was conducted among consented participants from the time of enrollment until graduation or 16 May 2025. Any participant diagnosed with a glenohumeral joint dislocation or subluxation confirmed by an orthopedic surgeon during the follow-up period was documented. The primary outcome of interest was time from enrollment until incident glenohumeral instability during follow-up. Univariate and multivariable logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (95%CI) to assess the association between baseline PROMs and the odds of incident shoulder instability injury during follow-up.
RESULTS: During the study period, 1,326 participants (22% female) consented to enroll in this study and 77 sustained an incident glenohumeral joint instability event during follow-up. The average age of participants at baseline was 18.9 (±1.63) years, their average height was 175.1 (±10.7) cm, and their average mass was 73.5 (±10.3) kg. In univariate analyses, baseline PROMIS Physical Function scores were associated with incident glenohumeral joint instability during follow-up (OR=0.93; 95%CI:0.89-0.98); however, Brief Resilience Scale scores were not (OR=0.85; 95%CI:0.59-1.24). For each point higher on the PROMIS Physical Function scale at baseline, participants were 7% less likely to sustain an incident glenohumeral joint instability event during follow-up. Baseline shoulder specific PROMs were also associated with incident glenohumeral joint instability during follow-up bilaterally for ASES and SANE scores. For the left shoulder, participants were 6 % less likely (OR=0.94;95%CI:0.89-0.99) to sustain an incident glenohumeral instability event for each point higher on the ASES and 8% less likely (OR=0.92;95%CI:0.87-0.95) for each point higher on the SANE at baseline. Similarly, for the right shoulder, participants were 4 % less likely (OR=0.96;95%CI:0.91-1.00) to sustain an incident glenohumeral instability event for each point higher on the ASES and 8% less likely (OR=0.96;95%CI:0.87-0.95) for each point higher on the SANE at baseline. Similar results were observed in multivariable models controlling for the influence of sex and history of glenohumeral joint instability at baseline.
DISCUSSION and CONCLUSION: Patient reported outcome measures collected upon accession to the military, particularly the PROMIS Physical Function scale and the SANE, appear to be associated with the subsequent risk of incident glenohumeral joint instability. Further research in a larger cohort is indicated to refine these prediction models and determine the utility of PROMs in combination with other demographic variables in estimating the risk of subsequent glenohumeral joint instability in military populations.