Anterior Cruciate Ligament Injury Risk in Sport: A Systematic Review and Meta-Analysis of Injury Incidence by Sex and Sport Classification.

OBJECTIVE: To evaluate sex differences in incidence rates (IRs) of anterior cruciate ligament (ACL) injury by sport type (collision, contact, limited contact, and noncontact). DATA SOURCES: A systematic review was performed using the electronic databases PubMed (1969-January 20, 2017) and EBSCOhost (CINAHL, SPORTDiscus; 1969-January 20, 2017) and the search terms anterior cruciate ligament AND injury AND (incidence OR prevalence OR epidemiology). STUDY SELECTION: Studies were included if they provided the number of ACL injuries and the number of athlete-exposures (AEs) by sex or enough information to allow the number of ACL injuries by sex to be calculated. Studies were excluded if they were analyses of previously reported data or were not written in English. DATA EXTRACTION: Data on sport classification, number of ACL injuries by sex, person-time in AEs for each sex, year of publication, sport, sport type, and level of play were extracted for analysis. DATA SYNTHESIS: We conducted IR and IR ratio (IRR) meta-analyses, weighted for study size and calculated. Female and male athletes had similar ACL injury IRs for the following sport types: collision (2.10/10 000 versus 1.12/10 000 AEs, IRR = 1.14, P = .63), limited contact (0.71/10 000 versus 0.29/10 000 AEs, IRR = 1.21, P = .77), and noncontact (0.36/10 000 versus 0.21/10 000 AEs, IRR = 1.49, P = .22) sports. For contact sports, female athletes had a greater risk of injury than male athletes did (1.88/10 000 versus 0.87/10 000 AEs, IRR = 3.00, P < .001). Gymnastics and obstacle-course races were outliers with respect to IR, so we created a sport category of fixed-object, high-impact rotational landing (HIRL). For this sport type, female athletes had a greater risk of ACL injury than male athletes did (4.80/10 000 versus 1.75/10 000 AEs, IRR = 5.51, P < .001), and the overall IRs of ACL injury were greater than all IRs in all other sport categories. CONCLUSIONS: Fixed-object HIRL sports had the highest IRs of ACL injury for both sexes. Female athletes were at greater risk of ACL injury than male athletes in contact and fixed-object HIRL sports.

A Novel Mass-Spring-Damper Model Analysis to Identify Landing Deficits in Athletes Returning to Sport After Anterior Cruciate Ligament Reconstruction.

Schneider, DK, Gokeler, A, Otten, E, Ford, KR, Hewett, TE, Divine, JG, Colosimo, AJ, Heidt, RS, and Myer, GD. A Novel mass-spring-damper model analysis to identify landing deficits in athletes returning to sport after anterior cruciate ligament reconstruction. J Strength Cond Res 31(9): 2590-2598, 2017-A mass-spring-damper (MSD) model may serve as an extension of biomechanical data from 3-dimensional motion analysis and epidemiological data which helps to delineate populations at risk for anterior cruciate ligament (ACL) injuries. The purpose of this study was to evaluate such a model. Thirty-six ACL reconstruction (ACLR) group subjects and 67 controls (CTRL) completed single-leg drop landing and single-leg broad jump tasks. Landing ground reaction force data were collected and analyzed with an MSD model. Medians, interquartile ranges, and limb symmetry indices (LSIs) were calculated and comparisons were made within and between groups. During a single-leg drop landing, the ACLR group had a lower spring LSI than the CTRL group (p = 0.015) and landed with decreased stiffness in the involved limb relative to the uninvolved limb (p = 0.021). The ACLR group also had an increased damping LSI relative to the CTRL group (p = 0.045). The ACLR subjects landed with increased stiffness (p = 0.006) and decreased damping (p = 0.003) in their involved limbs compared to CTRL subjects' nondominant limbs. During a single-leg forward broad jump, the ACLR group had a greater spring LSI value than the CTRL group (p = 0.045). The CTRL group also recorded decreased damping values in their nondominant limbs compared with the involved limbs of the ACLR group (p = 0.046). Athletes who have undergone ACLR display different lower-limb dynamics than healthy controls, according to an MSD model. Quadriceps dominance and leg dominance are components of ACLR athletes' landing strategies and may be identified with an MSD model and addressed during rehabilitation.

Sex comparison of familial predisposition to anterior cruciate ligament injury.

PURPOSE: In an effort to identify risk factors for anterior cruciate ligament (ACL) injury, many potential risk factors have been proposed, including familial predisposition. However, no study has evaluated familial predisposition in male or females separately. The purpose of this study was to determine whether a familial predisposition to ACL injury exists in both males and females. METHODS: One hundred and twenty (78 males and 42 females) patients who had undergone surgical ACL reconstruction were recruited as the ACL group, and 107 patients (67 males and 40 females) that had undergone arthroscopic partial menisectomy, with no previous history of ACL injury, were recruited as the referent control group. A familial ACL injury and subject particulars questionnaire was completed. RESULTS: When all subjects were combined, the ACL group (20.0 %, 24 of 120) did not demonstrate a higher familial (first-degree relative) prevalence (n.s.) of ACL injury compared to the referent control group (15.0 %; 16 of 107 patients). When the data were stratified by sex, the male ACL group (19.2 %, 15 of 78) demonstrated a significantly higher familial (first-degree relative) prevalence (P = 0.02) of ACL injury compared to the male referent control group (7.5 %; 5 of 67 patients). There were no differences among the females (n.s.). DISCUSSION: The results of this study show that male patients with ACL tears are more likely to have a first-degree relative with an ACL tear compared to male referent control subjects. Future research is warranted to better delineate sex-specific risk factors for ACL injuries could help guide intervention programs aimed at preventative treatment strategies, especially in high-risk families.

Augmented feedback supports skill transfer and reduces high-risk injury landing mechanics: a double-blind, randomized controlled laboratory study.

BACKGROUND: There is a current need to produce a simple, yet effective method for screening and targeting possible deficiencies related to increased anterior cruciate ligament (ACL) injury risk. HYPOTHESIS: Frontal plane knee angle (FPKA) during a drop vertical jump will decrease upon implementing augmented feedback into a standardized sport training program. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty-seven female participants (mean ± SD: age, 14.7 ± 1.5 years; height, 160.9 ± 6.8 cm; weight, 54.5 ± 7.2 kg) were trained over 8 weeks. During each session, each participant received standardized training consisting of strength training, plyometrics, and conditioning. They were also videotaped running on a treadmill at a standardized speed and performing a repeated tuck jump for 10 seconds. Study participants were randomized into 2 groups and received augmented feedback on either their jumping (AF) or sprinting (CTRL) form. Average (mean of 3 trials) and most extreme (trial with greatest knee abduction) FPKA were calculated from 2-dimensional video captured during performance of the drop vertical jump. RESULTS: After testing, a main effect of time was noted, with the AF group reducing their FPKA average by 37.9% over the 3 trials while the CTRL group demonstrated a 26.7% reduction average across the 3 trials (P < .05). Conversely, in the most extreme drop vertical jump trial, a significant time-by-group interaction was noted (P < .05). The AF group reduced their most extreme FPKA by 6.9° (pretest, 18.4° ± 12.3°; posttest, 11.4° ± 10.1°) on their right leg and 6.5° (pretest, 16.3° ± 14.5°; posttest, 9.8° ± 10.7°) on their left leg, which represented a 37.7% and 40.1% reduction in FPKA, respectively. In the CTRL group, no similar changes were noted in the right (pretest, 16.9° ± 14.3°; posttest, 14.0° ± 12.3°) or left leg (pretest, 9.8° ± 11.1°; posttest, 7.2° ± 9.2°) after training. CONCLUSION: Providing athletes with augmented feedback on deficits identified by the tuck jump assessment has a positive effect on their biomechanics during a different drop vertical jump task that is related to increased ACL injury risk. The ability of the augmented feedback to support the transfer of skills and injury risk factor reductions across different tasks provides exciting new evidence related to how neuromuscular training may ultimately cross over into retained biomechanics that reduce ACL injuries during sport. CLINICAL RELEVANCE: The tuck jump assessment's ease of use makes it a timely and economically favorable method to support ACL prevention strategies in young girls.

Effects of task-specific augmented feedback on deficit modification during performance of the tuck-jump exercise.

CONTEXT: Anterior cruciate ligament (ACL) injuries are prevalent in female athletes. Specific factors have possible links to increasing a female athlete's chances of suffering an ACL injury. However, it is unclear if augmented feedback may be able to decrease possible risk factors. OBJECTIVE: To compare the effects of task-specific feedback on a repeated tuck-jump maneuver. DESIGN: Double-blind randomized controlled trial. SETTING: Sports-medicine biodynamics center. PATIENTS: 37 female subjects (14.7 ± 1.5 y, 160.9 ± 6.8 cm, 54.5 ± 7.2 kg). INTERVENTION: All athletes received standard off-season training consisting of strength training, plyometrics, and conditioning. They were also videotaped during each session while running on a treadmill at a standardized speed (8 miles/h) and while performing a repeated tuck-jump maneuver for 10 s. The augmented feedback group (AF) received feedback on deficiencies present in a 10-s tuck jump, while the control group (CTRL) received feedback on 10-s treadmill running. MAIN OUTCOME MEASURES: Outcome measurements of tuck-jump deficits were scored by a blinded rater to determine the effects of group (CTRL vs AF) and time (pre- vs posttesting) on changes in measured deficits. RESULTS: A significant interaction of time by group was noted with the task-specific feedback training (P = .03). The AF group reduced deficits measured during the tuck-jump assessment by 23.6%, while the CTRL training reduced deficits by 10.6%. CONCLUSIONS: The results of the current study indicate that task-specific feedback is effective for reducing biomechanical risk factors associated with ACL injury. The data also indicate that specific components of the tuck-jump assessment are potentially more modifiable than others.

Increased plantar force and impulse in American football players with high arch compared to normal arch.

BACKGROUND: Risk of overuse injury among athletes is high due in part to repeated loading of the lower extremities. Compared to individuals with normal arch (NA) structure, those with high (HA) or low arch (LA) may be at increased risk of specific overuse injuries, including stress fractures. A high medial longitudinal arch may result in decreased shock absorbing properties due to increased rigidity in foot mechanics. While the effect of arch structure on dynamic function has been examined in straight line walking and running, the relationship between the two during multi-directional movements remains unstudied. OBJECTIVE: The purpose of this study was to determine if differences in plantar loading in football players occur during both walking and pivoting movements. METHOD: Plantar loading was examined in 9 regions of the foot for 26 participants (16 NA, 10 HA). RESULTS: High arch athletes demonstrated increased maximum force in the lateral rear foot and medial forefoot, and force time integral in the medial forefoot while walking. HA athletes also demonstrated increased maximum force in the medial rear foot and medial and central forefoot during rapid pivoting. CONCLUSIONS: The current findings demonstrate that loading patterns differ between football players with high and normal arch structure, which could possibly influence injury risk in this population.

No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction: evidence for objective return-to-sport criteria.

BACKGROUND: Release for full activity and return to sport after anterior cruciate ligament reconstruction (ACLR) is often dictated by time from surgery and subjective opinion by the medical team. Temporal guidelines for return to sport may not accurately identify impaired strength and neuromuscular control, which are associated with increased risk for second injury (contralateral and/or ipsilateral limb) after ACLR in athletes. HYPOTHESES: Athletes undergoing ACLR and returning to sport would demonstrate functional deficits that would not be associated with time from surgery. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty-three male (n = 10) and female (n = 23) athletes with unilateral ACLR, who were cleared by a physician to return to their sport after surgery and rehabilitation, performed the single-legged vertical hop test for 10 seconds on a portable force plate. Matched teammates of each patient were recruited to serve as sex-, sport-, and age-matched controls (CTRL; n = 67). Maximum vertical ground-reaction force (VGRF) was measured during each single-limb landing. Single-limb symmetry index (LSI) was calculated as the ratio of the involved divided by uninvolved limb, expressed as a percentage. RESULTS: The single-limb vertical jump height LSI was reduced in the ACLR group, 89% (95% confidence interval [CI], 83%-95%), compared with the matched CTRL group, 101% (95% CI, 96%-105%; P < .01). The LSI for VGRF normalized to potential energy achieved during flight of the hop was increased in ACLR at 112% (95% CI, 106%-117%) relative to the CTRL group at 102% (95% CI, 98%-106%; P < .01). Linear regression analysis indicated that time from surgery was not associated with limb symmetry deficits in the ACLR group (P > .05; R (2) = .002-.01). CONCLUSION: Deficits in unilateral force development (vertical jump height) and absorption (normalized VGRF) persist in an athlete's single-limb performance after ACLR and full return to sports. These symmetry deficits appear to be independent of time after reconstruction. CLINICAL RELEVANCE: On the basis of these results, clinicians should consider assessment of single-limb power performance in the decision-making process for return-to-sport release. Persistent side-to-side asymmetries may increase the risk of contralateral and/or ipsilateral injury.

Utilization of modified NFL combine testing to identify functional deficits in athletes following ACL reconstruction.

STUDY DESIGN: Case control. OBJECTIVES: To use modified NFL Combine testing methodology to test for functional deficits in athletes following anterior cruciate ligament (ACL) reconstruction following return to sport. BACKGROUND: There is a need to develop objective, performance-based, on-field assessment methods designed to identify potential lower extremity performance deficits and related impairments in this population. METHODS: Eighteen patients (mean ± SD age, 16.9 ± 2.1 years; height, 170.0 ± 8.7 cm; body mass, 71.9 ± 21.8 kg) who returned to their sport within a year following ACL reconstruction (95% CI: 7.8 to 11.9 months from surgery) participated (ACLR group). These individuals were asked to bring 1 or 2 teammates to serve as control participants, who were matched for sex, sport, and age (n = 20; mean ± SD age, 16.9 ± 1.1 years; height, 169.7 ± 8.4 cm; body mass, 70.1 ± 20.7 kg). Functional performance was tested using the broad jump, vertical jump, modified long shuttle, modified pro shuttle, modified agility T-test, timed hop, triple hop, single hop, and crossover hop tests. A 1-way multivariate analysis of variance (MANOVA) was used to evaluate group differences for dependent performance variables. RESULTS: The functional performance measurements of skills requiring bilateral involvement of both lower extremities showed no group differences between the ACLR and control groups (P>.05). An overall group difference (P = .006) was observed for the combined limb symmetry index (LSI) measures. However, the modified double-limb performance tasks (long shuttle, modified agility T-test, and pro shuttle) were not, independently, sufficiently sensitive to detect limb deficits in individuals with ACL reconstruction. Conversely, the LSI on the distance measures of the single-limb performance tasks all provided moderate to large effect sizes to differentiate between the ACLR and control groups, as the individuals who had ACL reconstruction demonstrated involved limb deficits on all measures (P<.05). Finally, the LSI for the timed hop test was not different between groups (P>.05). CONCLUSIONS: These findings indicate that, while unilateral deficits are present in individuals following ACL reconstruction, they may not be evident during bipedal performance or during modified versions of double-limb performance activities. Isolation of the involved limb with unilateral hopping tasks should be used to identify deficits in performance.

ANTERIOR CRUCIATE LIGAMENT TEAR IN AN ATHLETE: DOES INCREASED HEEL LOADING CONTRIBUTE TO ACL RUPTURE?

Rupture to the anterior cruciate ligament is a common athletic injury in American football. The lower extremity biomechanics related to increased ACL injury risk are not completely understood. However, foot landing has been purported to be a significant contributing factor to the ACL injury mechanism. In this case report, information is presented on an athlete previously tested for in-shoe loading patterns on artificial turf and subsequently went on to non-contact ACL rupture on the same surface. This case report describes the specific findings in a study participant who suffered an ACL rupture after testing and suggests that flatfoot tendency in running and cutting maneuvers might lead to an increased risk of ACL injury.

Comparison of in-shoe foot loading patterns on natural grass and synthetic turf.

Synthetic playing surfaces with rubber or sand infill are now used on many athletic fields such as soccer, football and rugby. Although these surfaces may come closer to the mechanical characteristics of a true grass playing surface than the older turf designs, their potential effects on lower extremity biomechanics and related injury rates necessitate further study. The purpose of this study was to examine the effects of two surfaces (natural grass versus turf) on in-shoe foot loading patterns during cutting. Seventeen male football players were tested on a slalom course. An in-shoe pressure distribution measurement insole was used in the right shoe (14 stud, molded cleat) of each athlete. Individual cutting steps were extracted from each slalom trial and peak pressure and relative load calculated in nine distinct plantar regions of the foot. The turf condition had significantly higher peak pressures within the central forefoot (turf: 646.6+/-172.6 kPa, grass: 533.3+/-143.4 kPa, P=0.017) and lesser toes (turf: 429.3+/-200.9 kPa, grass: 348.1+/-119.0 kPa, P=0.043) compared to grass. In contrast, the relative load within the medial forefoot (turf: 27.2+/-5.3%, grass: 30.2+/-6.6%, P=0.031) and lateral midfoot (turf: 3.4+/-1.8%, grass: 4.1+/-2.3%, P=0.029) were higher during the grass condition. No differences between the grass and turf were found in maximal effort sprint times performed prior to the testing trials. This study demonstrates that playing surface significantly affects plantar loading during sport related activities. Further epidemiological investigation is warranted to determine the effects of playing surfaces on sport specific injury mechanisms.

Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study.

BACKGROUND: Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes. HYPOTHESIS: Prescreened female athletes with subsequent anterior cruciate ligament injury will demonstrate decreased neuromuscular control and increased valgus joint loading, predicting anterior cruciate ligament injury risk. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: There were 205 female athletes in the high-risk sports of soccer, basketball, and volleyball prospectively measured for neuromuscular control using 3-dimensional kinematics (joint angles) and joint loads using kinetics (joint moments) during a jump-landing task. Analysis of variance as well as linear and logistic regression were used to isolate predictors of risk in athletes who subsequently ruptured the anterior cruciate ligament. RESULTS: Nine athletes had a confirmed anterior cruciate ligament rupture; these 9 had significantly different knee posture and loading compared to the 196 who did not have anterior cruciate ligament rupture. Knee abduction angle (P<.05) at landing was 8 degrees greater in anterior cruciate ligament-injured than in uninjured athletes. Anterior cruciate ligament-injured athletes had a 2.5 times greater knee abduction moment (P<.001) and 20% higher ground reaction force (P<.05), whereas stance time was 16% shorter; hence, increased motion, force, and moments occurred more quickly. Knee abduction moment predicted anterior cruciate ligament injury status with 73% specificity and 78% sensitivity; dynamic valgus measures showed a predictive r2 of 0.88. CONCLUSION: Knee motion and knee loading during a landing task are predictors of anterior cruciate ligament injury risk in female athletes. CLINICAL RELEVANCE: Female athletes with increased dynamic valgus and high abduction loads are at increased risk of anterior cruciate ligament injury. The methods developed may be used to monitor neuromuscular control of the knee joint and may help develop simpler measures of neuromuscular control that can be used to direct female athletes to more effective, targeted interventions.

Simultaneous ACL and PCL reconstruction.

The results of 11 patients who underwent simultaneous arthroscopically assisted anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction for acute (n=7) or chronic (n=4) multiligamentous knee injuries were reviewed. Seven patients were treated with a bone-patellar tendon-bone (BPTB) autograft for the ACL reconstruction and an Achilles allograft for the PCL reconstruction, three patients with ipsilateral/contralateral BPTB autografts, and one patient with BPTB allograft for ACL and Achilles allograft for PCL. Seven patients were operated on acutely (<3 months postinjury), and 4 were treated for chronic conditions. At follow-up, all patients were subjectively and functionally evaluated with a Lysholm Knee Scoring Scale. Average patient age at surgery was 29 years, and average postoperative follow-up was 28.4 months. Average postoperative Lysholm score was 87.7 (range: 49-100). Four of 11 patients reported occasional mild pain, 2 occasional swelling, and 4 infrequent instability. No patient required a postoperative manipulation to regain his or her range of motion and 10 of the 11 returned to their previous activity level postoperatively. Of the 10 patients able to return for clinical examination, 2 demonstrated a loss of flexion <5 degrees compared to the other side, 7 demonstrated a mild postoperative posterior drawer at 90 degrees (6 at 1+, 1 at 2+), 3 demonstrated a positive Lachman (grade 1), whereas no patient demonstrated any posterior lateral corner instability. The average anterior active difference on KT-1000 was 2.6 (range: 0-6). Simultaneous reconstruction of the ACL and PCL, although technically difficult, is feasible and yields good to excellent functional results.

Physiologic axial load, frictional resistance, and the football shoe-surface interface.

The purpose of this investigation was to report on the interaction between different types of athletic shoes and playing surfaces using physiologic loads of 40 and 220 lbs. This is a continuation of our previous report using a load of 25 lbs. Nine shoes by three manufacturers were characterized as turf, court, molded cleat, or traditional cleat and tested on both natural grass and synthetic turf. A specially designed pneumatic testing device was used in order to measure translational resistance and rotational torque of the shoe-surface interface. Measurements were acquired for 1) force-X describing translational loading, 2) moment-Y describing the torque generated by linear translation, and 3) moment-Z describing the moment generated by axial rotation, and data were analyzed using repeated measures analysis of variance and Tukey's post-hoc comparison. It was found that increased the axial loads from 40 to 220 lbs significantly increased the frictional resistance (p < .05) between the shoe and the artificial turf surface in a nonlinear fashion. Turf shoes demonstrated the most frictional resistance of any group for this condition. Increases in the forces generated in linear translation from the axial load of 40 to 220 lbs produced the most significant increases of any resistance test on the turf surface. The cleated shoes (both traditional and molded) generated the highest frictional and torsional resistance on the grass surface when compared to the other categories of shoes. Grass generated higher peak moments than turf for the cleated shoes. These results demonstrate the considerable differences between laboratory and physiologic conditions and that the increase in frictional resistance is nonlinear with increasing loads.

Effects of iontophoretic versus injection administration of dexamethasone.

PURPOSE: Sixty-eight skeletally mature New Zealand white rabbits were used to study the effects of iontophoresis- and injection-delivered sodium phosphate dexamethasone (DX) on the morphologic, histologic, microscopic, and biomechanical properties of uninjured rabbit patellar tendons over an initial 14-d period. METHODS: Three control (untreated, placebo iontophoresis, and placebo injection) groups and two treatment (iontophoresis and injection) groups underwent serum, ELISA tendon, histology, electron microscopy, and biomechanical analysis. RESULTS: Serum DX levels were detectable and quantifiable in both treatment groups at 1 h but were significantly greater (P < 0.05) in the injected group (11.29 ng.mL-1) compared with the iontophoresis group (6.34 ng.mL-1). The most significant histologic finding was a lack of a cellular inflammatory response in the DX-treated groups at 24 h. Ultrastructural analysis produced no significant differences between size or size ratio of collagen fibrils among any groups. Morphologic examination revealed only injection puncture marks seen in appropriate tendons. Biomechanical testing produced disruption at the patellar insertion in 81% of the specimens. No injected tendon failed at the injection site. Normalized biomechanical properties included: 1) Stiffness increased in control and iontophoresis groups from 1 to 24 h, then gradually declined; the DX-injected specimens showed a similar but delayed effect. 2) Peak load at failure for iontophoresis and control groups was greatest at 24 h. The DX-injected group again showed a delayed response. 3) In general, total energy to failure revealed no significant differences between groups at any time period. CONCLUSION: It appears that iontophoresis or injection-delivered DX may produce anti-inflammatory effects without significantly altering ultrastructural or biomechanical characteristics of the rabbit patellar tendon within an initial 14-d period.

Arthroscopic laser-assisted capsular shift in the treatment of patients with multidirectional shoulder instability.

BACKGROUND: In recent years, various investigators have begun using lasers in the treatment of shoulder instability. HYPOTHESIS: Arthroscopic laser-assisted capsular shift is an effective treatment for patients with multidirectional shoulder instability. STUDY DESIGN: Retrospective cohort study. METHODS: We retrospectively identified 28 patients (30 shoulders) with multidirectional shoulder instability who were unresponsive to nonoperative management and who had undergone the laser-assisted capsular shift procedure. Twenty-five patients (27 shoulders) with an average follow-up of 28 months were available for review. All patients underwent a physical examination and completed a general questionnaire; the University of California, Los Angeles, shoulder rating scale; the Western Ontario Shoulder Instability Index; and the Short-Form 36 quality of life index. RESULTS: In 22 shoulders, results of the procedure were considered a success because the patients had no recurrent symptoms and at latest follow-up had required no further operative intervention. In five shoulders, results were considered a failure because of recurrent pain or instability and the need for an open capsular shift procedure. With recurrent instability as a measure of failure, the overall success rate was 81.5%. CONCLUSIONS: Our results with laser-assisted capsular shift are comparable with the results of other open and arthroscopic techniques in relieving pain and returning athletes to their premorbid function.