Do I Need Surgery after a Shoulder Dislocation?

Primary Arthroscopic Stabilization for a First-Time Anterior Dislocation of the Shoulder: Long-Term Follow-up of a Randomized, Double-Blinded Trial (JBJS 2020)  

What was the purpose of this study?  

The aim of this study was to evaluate the long-term efficacy of arthroscopic Bankart repair (ABR). Basically, should we fix it or not? 

How did the authors study their question?  

•  88 patients with an age of ≤35 years who had sustained their 1st anterior glenohumeral dislocation were enrolled in a single-center, double-blinded clinical trial. 
•  Subjects were randomized to receive either an arthroscopic washout (AWO) *placebo* or ABR. Participants were reassessed after a minimum of 10 years postoperatively. 
•  Data regarding recurrent instability, revision surgery, satisfaction, and function (Disabilities of the Arm, Shoulder and Hand [DASH] and Western Ontario Shoulder Instability Index [WOSI]) scores were collected. 

What did the authors find? 

•  Sixty-five patients (74%; 32 in the AWO group and 33 in the ABR group) were included and had an average follow-up of 14.2 years (range,12 to 16 years). 
•  The rate of recurrent dislocation was significantly higher in the AWO group than the ABR group (47% and 12%, respectively; p = 0.002). Kaplan-Meier curves were plotted for event-free survival using recurrent instability and/or revision surgery as clinical end points. 
•  This analysis demonstrated a sustained significant difference between the groups at 10 years after surgery (58% for the AWO group versus 79% for the ABR group; log-rank test [Mantel-Cox]; p = 0.018). 
•  Long-term WOSI scores were significantly better in the ABR group. 
•  The presence of recurrent instability was associated with significantly poorer WOSI and DASH scores.  

How does this impact my clinical practice? 

This study demonstrates a long-term benefit in overall shoulder stability and functional outcome in high-risk patients who have undergone ABR for first-time anterior dislocation. In brief, there is utility in fixing the first time dislocator.

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Further Evidence: @AJSM.2021.Apr;49(5)

In patients with first-time shoulder dislocations, arthroscopic labral repair (Bankart procedure) reduced the risk of secondary shoulder dislocation and improved functional outcome versus nonoperative treatment after a 2-year follow-up.

The risk of recurrence after the first episode of anterior shoulder dislocation is high with nonoperative treatment in younger patients.

Author

Dr. Catherine Logan, MD, MBA Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.