Anterior dislocation of the shoulder in skeletally immature patients: Comparison between non-operative treatment versus open Latarjet’s procedure

Authors: A. Khan, A. Samba, B. Pereira, and F. Canavese

References: Bone Joint J March 2014 96-B:354-359.

The ideal treatment for traumatic anterior dislocation of the shoulder in the skeletally immature patient is controversial. The aim of this study is to evaluate the outcomes after either conservative and/or surgical treatment using the Latarjet technique. A retrospective series of 49 out of 80 patients were reviewed. We found no significant differences between either treatment method regarding functional scores and pain levels. Although not statistically significant, post-surgical patients showed better signs of shoulder stability than others who have a higher rate of recurrence. Further, 92% of the post-surgical group had returned to the same level of activity versus 52% in the non-surgically treated group. We found no contraindications to operate on a skeletally immature patient.

Comment (Len Funk): 
  • Very useful study with a 7 year follow-up period. 
  • The average patient age was 15.9 in both groups. 
  • Time from dislocation to surgery 14.5 months, which suggests failed non-operative treatment for a period (?)
  • ISIS scores were higher in the operative group (8.7 vs 6.7) - suggests not comparable in terms of instability
  • Latarjet patients had less recurrences and better stability at 7 yr follow up.
  • Latarjet patients also had higher return to sport
  • Very low complications with surgery and none had OA on radiographs
This article does show that it is reasonable to offer a Latarjet procedure to adolescent athletes with anterior shoulder instability and high ISIS score, with low complication rates and low risk of arthritis at 7 years.


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