Operative Repair Best for First-Time Shoulder Dislocation
References: Am J Sports Med. 2002;30(4):576-580
Operative repair of first-time, acute, traumatic shoulder dislocation substantially reduces recurrence compared with the standard nonoperative approach, according to the results of a prospective randomized trial in the July/August issue of the American Journal of Sports Medicine. Based on these findings, the investigators recommend this procedure to all athletes younger than 25 with this injury. "Nonoperative treatment of traumatic shoulder dislocations leads to a high rate of recurrent dislocations," write Craig R. Bottoni, MD, and colleagues from the CR Tripler Army Medical Center in Honolulu, Hawaii. "Arthroscopic stabilization of traumatic, first-time anterior shoulder dislocations is an effective and safe treatment that significantly reduces the recurrence rate of shoulder dislocations in young athletes when compared with conventional, nonoperative treatment." The investigators compared two groups of young athletes with acute, traumatic shoulder dislocations: 14 nonoperatively treated patients who underwent four weeks of immobilization and 10 operatively treated patients who had arthroscopic Bankart repair with a bioabsorbable tack. All patients had a supervised rehabilitation program; average follow-up was 36 months; and three patients were lost to follow-up. Of 12 nonoperatively treated patients seen in follow-up, nine (75%) developed recurrent instability, including six who required subsequent open Bankart repair. Of the nine operatively treated patients seen in follow-up, only one (11.1%) developed recurrent instability. "Our current approach is to offer young, athletic patients (<25 years) with known high recurrence rates the option of arthroscopic repair in the acute stage after injury," the authors write. "On the basis of our previous work and that of others cited, we believe that this treatment is more predictable, lowers recurrence rates, and improves overall outcome."