Arthroscopic Bankart Repair Versus Nonoperative Treatment for Acute, Initial Anterior Shoulder Dislocations

Abstract

A prospective study evaluating nonoperative treatment versus arthroscopic Bankart suture repair for acute, initial dislocation of the shoulder was undertaken in young athletes. All patients met the following criteria: 1) sustained an acute first-time traumatic anterior dislocation, 2) no history of impingement or occult subluxation, 3) the dislocation required a manual reduction, and 4) no concomitant neurologic injury. Thirty-six athletes (average age, 20 years) met the criteria for inclusion. Group I patients were immobilized for 1 month followed by rehabilitation; they were allowed full activity at 4 months. Group II patients underwent arthroscopic Bankart repair followed by the same protocol as Group I. Group I consisted of 15 athletes. Twelve patients (80%) developed recurrent instability; 7 of the 12 have required open Bankart repair for recurrent instability. Group II consisted of 21 patients; 18 patients (86%) had no recurrent instability at last followup (average, 32 months; range, 15 to 45) (P = 0.001). One patient in Group II has required a subsequent open Bankart repair to treat symptomatic recurrence (P = 0.005). In this study, arthroscopic Bankart repair significantly reduced the recurrence rate in young athletes who sustained an acute, initial anterior dislocation of the shoulder.

Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss

“…1 Nonoperative management of glenohumeral instability has been associated with high rates of recurrence in multiples studies, with recurrence rates ranging from 37% to 85%. [2][3][4][5][6][7][8][9] Arthroscopic stabilization procedures have been similarly associated with recurrent instability, with recurrence rates ranging from 10.8% to 21.1%. [10][11][12][13] As a result, it has become essential for physicians to recognize clinical factors that place patients at increased risk of failed nonoperative or arthroscopic treatment.…”

Arthroscopic Repair versus Non-operative Treatment of First-time Traumatic Anterior Shoulder Dislocations: A Numbers-needed-to-treat Analysis for Prevention of Recurrent Dislocations

“…1 and 2, respectively. Across all six studies, [12][13][14][15][16][17] the arthroscopic surgical treatment showed a decreased rate of recurrent shoulder dislocations or subluxations when compared to the non-operative treatment. Calculated pooled result of NNT was a positive number of 1.76 (95% CI=1.50 to 2.13), indicating that two arthroscopic surgical repairs would need to be performed in order to prevent one recurrent episode.…”

“…More specifically, these articles included a comparison between different surgical techniques (e.g., open vs. arthroscopic), patients with shoulder dislocations rather than anterior direction (e.g., posterior instability), patients with multiple dislocations (e.g., not first-time), different outcome measures (e.g., cost effectiveness), only recorded outcome measures from the surgical treatment (e.g., absence of the control). Among the remaining 11 relevant studies, [12][13][14][15][16][17][18][19][20][21][22] five articles [18][19][20][21][22] were further excluded. One study, 18) which was a longer-term follow-up to the same patients used in another study, 16) and was included in the pooled data, was excluded.…”

“…20) One article was excluded because only an abstract was published. 19) Therefore, six studies [12][13][14][15][16][17] were finally pooled. The average follow-up time was 56 months.…”

Nonoperative rehabilitation for traumatic and atraumatic glenohumeral instability

“…In athletes involved in collision sports, the recurrence rates have been reported collision sports, the recurrence rates have been reported between 86-94%. 6,[40][41][42] …”