Do Articular-Sided Partial-Thickness Rotator Cuff Tears After a First-Time Traumatic Anterior Shoulder Dislocation in Young Athletes Influence the Outcome of Surgical Stabilization?

Abstract

Background:Because of the high risk for redislocations after a first-time traumatic anterior shoulder dislocation with conservative treatment, recent publications have recommended early arthroscopic intervention, especially for young athletes. Concomitant rotator cuff tendon damage may occur when the shoulder dislocates; however, its presence and influence on clinical results have not been well described in this patient category.Hypothesis:In opposition to current opinion, a substantial number of articular-sided partial-thickness rotator cuff tears (APTRCTs) would be found at surgery after a first-time traumatic anterior shoulder dislocation in young athletes. However, the impact of these injuries on 2-year postoperative results would be negligible.Study Design:Cohort study; Level of evidence, 3.Methods:Sixteen male patients (mean age, 21 years [range, 16-25 years]) with a first-time traumatic anterior shoulder dislocation without bony Bankart lesions were included in this study. The indications for surgical treatment were age less than 25 years and being active in collision or contact sports at a competitive level. Arthroscopic surgery was performed at a mean 7.8 days (range, 2-14 days) after injury. Rowe and American Shoulder and Elbow Surgeons (ASES) scores as well as range of motion were evaluated at a minimum 2 years after an arthroscopic Bankart procedure, and a comparison of the clinical results between patients with and without APTRCTs was conducted.Results:An anterior-inferior capsulolabral injury was found in all patients. There were no bony Bankart lesions. An APTRCT was found in 9 of the 16 patients. At 2 years after surgical treatment, there were no significant differences between the patients with and without APTRCTs in terms of the Rowe score (90.0 and 87.1, respectively; P = .69) and ASES score (94.6 and 90.4, respectively; P = .67).Conclusion:APTRCTs were found in the superior part of the shoulder joint after a first-time traumatic anterior shoulder dislocation in a majority of young male athletes treated with surgical stabilization. There were no significant differences found between patients with and without APTRCTs in terms of the Rowe and ASES scores at 2 years after surgical treatment.

Postoperative Management Following Arthroscopic Bankart Repair in Adolescents and Young Adults: A Systematic Review

“…Of the studies, 10 were conducted in the United States, 2 , 5 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 2 in the United Kingdom, 26 , 27 2 in Italy, 6 , 28 and 1 study each in France, 29 Greece/Germany 30 and Estonia. 31 The articles included in this review involved a total of 675 patients (690 shoulders). The mean sample size in all the studies was 39.7 patients (40.6 shoulders) with a mean age of 18.3 years.…”

“… 24 2013 USA 19.5 (12-24) 58 27 11 81 IV Rahu et al. 31 2018 Estonia 21 (16-25) 16 32 11 72 IV Saper et al. 25 2017 USA 16.9 (15-19) 39 75.6 11 76 IV Torrance et al.…”

“…Most studies were Level IV studies (case series). 2 , 19 , 22 , 23 , 24 , 25 , 27 , 28 , 29 , 31 There were 4 Level III studies (retrospective group) 18 , 20 , 21 , 26 and 3 Level II studies (prospective group). 5 , 6 , 30 The average MINORS score for the noncomparative studies was 11 (range, 9-12), whereas the average MINORS score for the comparative studies was 18.8 (range, 18-20) ( Table 1 ).…”

“…Also, a clearly defined time period determining when young athletes should be allowed to RTS has not been established. There is substantial variability among each Dependent on sportspecific training and sport/ activity demands Mazzocca et al 2 Active assisted ROM 2 weeks 6 months, depending on ROM and strength comparison to contralateral shoulder Nixon et al 26 Upon completion of sportspecific rehabilitation Owens et al 23 Any 31 Passive ROM 4 weeks 4 months Saper et al 25 Active external rotation, extension, or abduction of the shoulder…”

“…2,6,18,24,25,28,30 A sling and swathe were given to patients in 2 studies 6,24 ; 3 studies did not specify the type of immobilization utilized. 20,27,31 The position of immobilization was listed specifically in 5 studies and varied among them. In 2 studies, the arm was positioned in adduction and internal rotation but used different types of immobilization; Jones et al 21 used a shoulder immobilizer, and De Carli et al 6 used a sling and swathe brace when positioning patients in adduction and internal rotation.…”