Introduction Anterior dislocations, the most common type of shoulder dislocation, are often complicated by subsequent instability. With recurrent dislocations there often is attrition of the labrum and progressive loss of the anterior bony contour of the glenoid. Treatment options for this pathology involve either soft tissue repair or bony augmentation procedure. The optimal management remains unknown and current clinical practice is highly varied. Methods and analysis The Shoulder instability Trial comparing Arthroscopic stabilization Benefits compared with Latarjet procedure Evaluation (STABLE) is an ongoing multi-centre, pilot randomized controlled trial of 82 patients who have been diagnosed with recurrent anterior shoulder instability and subcritical glenoid bone loss. Patients are randomized to either soft tissue repair (Bankart + Remplissage) or bony augmentation (Latarjet procedure). The primary outcome for this pilot is to assess trial feasibility and secondary outcomes include recurrent instability as well as functional outcomes up to two years post-operatively. Conclusions This trial will help to identify the optimal treatment for patients with recurrent shoulder instability with a focus on determining which treatment option results in reduced risk of recurrent dislocation and improved patient outcomes. Findings from this trial will guide clinical practice and improve care for patients with shoulder instability. Trial registration This study has been registered on http://www.ClinicalTrials.gov with the following identifier: ClinicalTrials.gov Identifier: NCT03585491, registered 13 July 2018, https://www.clinicaltrials.gov/ct2/show/NCT03585491?term=NCT03585491&draw=2&rank=1. Ethics and dissemination This study has ethics approval from the McMaster University/Hamilton Health Sciences Research Ethics Board (REB) (approval #4942). Successful completion will significantly impact the global management of patients with recurrent instability. This trial will develop a network of collaboration for future high-quality trials in shoulder instability.
El éxito del tratamiento de la displasia de caderas consiste en lograr una reducción concéntrica y evitar la displasia residual. Uno de los factores esenciales es el diagnóstico y tratamiento precoz. Objetivo: evaluar la relación entre la edad de inicio de tratamiento de displasia de caderas y la presencia de displasia residual al año de edad. Pacientes y Método: Estudio pronóstico retrospectivo. Se seleccionaron pacientes con displasia de cadera tratados con correas de Pavlik en un centro terciario. Se definió displasia residual como un índice acetabular mayor a 28 grados al año de edad. Se determinó asociación de displasia residual con edad de inicio de tratamiento, bilateralidad e índice acetabular mayor a 36 grados. Se utilizaron las pruebas de T-Student, ChiCuadrado e índice de Youden. Se consideró significativo un valor-p < 0,05. Se utilizó el programa STATA v.16. Resultados: Se incluyeron 153 pacientes (262 caderas), 84,3% (129) mujeres, 71,2% (109) con displasia bilateral. Cincuenta y nueve caderas (22,52%) presentaron displasia residual, encontrándose asociación significativa con la edad de inicio de tratamiento (p = 0,03), displasia bilateral (p < 0,01) e índice acetabular mayor a 36 grados (p = 0,01). La edad de inicio posterior a los 4.5 meses aumentó el riesgo de displasia residual en 2.5 veces. (IC95% 1,25-5,03) Conclusión: Se observó aumento de la displasia residual en inicio de tratamiento mayor a 4,5 meses. Es relevante considerar este resultado en las guías clínicas locales para lograr un diagnóstico y tratamiento exitosos.
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