Surgical outcomes in the Frequency, Etiology, Direction, and Severity (FEDS) classification system for shoulder instability: Influence Statistics

Expert Impact

Concepts for which they have has direct influence: Shoulder instability , Patients anterior , Shoulder dislocation , Joint instability , Humans joint , Shoulder elbow , 1 patients .

Key People For Shoulder Instability

Top KOLs in the world
Russell F Warren
rotator cuff cruciate ligament shoulder arthroplasty
Anthony A Romeo
rotator cuff shoulder arthroplasty biceps tenodesis
Pascal Boileau
shoulder arthroplasty proximal humerus rotator cuff
Stephen S Burkhart
rotator cuff subscapularis tendon arthroscopic repair
Robert A Arciero
cruciate ligament shoulder instability posterolateral corner
Eijii Itoi
rotator cuff external rotation shoulder pain

Surgical outcomes in the Frequency, Etiology, Direction, and Severity (FEDS) classification system for shoulder instability


. BACKGROUND: The Frequency, Etiology, Direction, and Severity (FEDS) system was developed as a simple but reliable method for classifying shoulder instability based on 4 factors attainable by history and physical examination: frequency (solitary, occasional, or frequent); etiology (traumatic or atraumatic); direction (anterior, posterior, or inferior); and severity (subluxation or dislocation). This study investigated the epidemiology and 2-year surgical outcomes for the FEDS categories in the prospective Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort. METHODS: At the time of surgery, 1204 patients were assigned to the FEDS categories. Follow-up data were available for 636 of 734 patients (86.6%) who had undergone surgery at least 2 years prior to analysis. The most common categories were further analyzed by patient-reported outcomes (PROs) (American Shoulder and Elbow Surgeons, Western Ontario Shoulder Instability index, Single Assessment Numeric Evaluation scores) and rates of recurrent subluxation, recurrent dislocation, and revision surgery. RESULTS: Of the 36 FEDS categories, 16 represented at least 1% of patients. Occasional traumatic anterior dislocation (OTAD) was the most common category, with 16.4% of patients. Five other anterior categories (solitary traumatic anterior subluxation, occasional traumatic anterior subluxation [OTAS], frequent traumatic anterior subluxation [FTAS], solitary traumatic anterior dislocation, and frequent traumatic anterior dislocation) and one posterior category (solitary traumatic posterior subluxation [STPS]) represented at least 5% of patients. PROs improved significantly for each category. The highest rates of recurrent subluxation occurred in FTAS, OTAS, and OTAD cases; dislocation, OTAS and FTAS cases; and further surgery, OTAD cases. The lowest rates of failure occurred in STPS cases. Downward trends in PROs and higher failure rates were noted with an increasing number of preoperative dislocations. CONCLUSION: Different FEDS categories showed varying degrees of improvement and failure rates, indicating that the system can be used to provide prognostic insight for presurgical education. Overall, outcomes decreased with a higher number of preoperative dislocations.