Functional Outcome and Risk of Recurrent Instability After Primary Traumatic Anterior Shoulder Dislocation in Young Patients

Robinson, C. M.; Howes, Jonathan B.; Murdoch, Helen; Will, E.; Graham, Catriona

doi:10.2106/00004623-200611000-00002

Cited by 149 publications

(86 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the contrary, other studies were not able to establish a significant cut off value [30,34,51]. It is worth mentioning that other studies showed that age at the time of first dislocation (the impact of age at the time of surgery was not taken into consideration) correlated negatively with instability [42][43][44]48]. These studies discussed the risk factors for recurrence after anterior shoulder instability in general, not focusing on a specific surgical intervention.…”

Section: Early Versus Late Postoperative Recurrencementioning

confidence: 94%

Mid-term to long-term results of primary arthroscopic Bankart repair for traumatic anterior shoulder instability: a retrospective study

Panzram

Kentar

Maier

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background: The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. The aim of the study is to determine the mid−/long-term functional outcome, failure rates and predictors of failure after primary arthroscopic Bankart repair for traumatic anterior shoulder instability. Methods: A total of 100 patients were primarily operated using arthroscopic Bankart repair after traumatic anterior shoulder instability. Medical records were retrospectively reviewed, and patients were assessed using postal questionnaire after a mean follow-up of 8.3 years [3][4][5][6][7][8][9][10][11][12][13][14]. Clinical assessment was performed using Constant score, Rowe score, and American Shoulder and Elbow Surgeons score. Results: The overall recurrence rate was 22%. The Kaplan-Meier failure-free survival estimates. were 80% at 5 years and 70% at 10 years. Nearly half (54.5%) of recurrences occurred at 2 years postoperative. Compared with normal shoulder, there were statistical differences in all 3 scores. Failure rate was significantly affected by age at the time of surgery with 86% of recurrence cases observed in patients aged 30 years or younger. Nevertheless, Younger age at the time of surgery (P = 0.007) as well age at the time of initial instability (P = 0.03) was found to correlate negatively with early recurrence within 2 years of surgery. Among those with recurrent instability, recurrence rate was found to be higher if there had been more than 5 instability episodes preoperatively (P = 0.01). Return to the preinjury sport and occupational level was possible in 41 and 78%, respectively. Conclusion: Failure-free survival rates dropped dramatically over time. Alternative reconstruction techniques should be considered in those aged ≤30 years due to the high recurrence rate.

show abstract

Section: Early Versus Late Postoperative Recurrencementioning

confidence: 94%

Mid-term to long-term results of primary arthroscopic Bankart repair for traumatic anterior shoulder instability: a retrospective study

Panzram

Kentar

Maier

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…Moreover, the primary endpoint was objectively registered anterior shoulder redislocation, which usually does not occur until 12 to 24 months after a primary traumatic ASD. 40 Therefore, from RCTs, little is known about patients with primary and recurrent traumatic ASDs on short-term and subjective outcomes of shoulder symptoms and function. 25 Furthermore, in qualitative, cross-sectional, and cohort studies, it was reported that many patients (*50%) with a primary traumatic ASD who had been treated nonsurgically did not experience recurrent ASDs, whereas shoulder function in general was poor.…”

mentioning

confidence: 99%

Neuromuscular Exercises Improve Shoulder Function More Than Standard Care Exercises in Patients With a Traumatic Anterior Shoulder Dislocation: A Randomized Controlled Trial

Eshøj

Rasmussen

Frich

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: There is an important gap in knowledge about the effectiveness of nonoperative treatment (exercise) for patients with traumatic primary and recurrent anterior shoulder dislocations (ASDs).Purpose/Hypothesis: The purpose of this study was to assess the efficacy and safety of physical therapist-supervised, shoulder instability neuromuscular exercise (SINEX) versus self-managed, home-based, standard care shoulder exercise (HOMEX) in patients with traumatic ASDs. The hypothesis was that SINEX would have a larger effect and fewer adverse events compared with HOMEX.Study Design: Randomized controlled trial; Level of evidence, 2.Methods: A total of 56 participants with radiographically verified, trauma-initiated primary or recurrent ASDs and self-reported decreased shoulder function were randomized to 12 weeks of either SINEX or HOMEX. The SINEX program consisted of 7 exercises, individually progressing from basic (2 Â 20 repetitions each day) to elite (2 Â 10 repetitions, 3 times weekly). The HOMEX program included 5 shoulder exercises performed 3 times weekly (2 Â 10 repetitions). The primary outcome was the Western Ontario Shoulder Instability Index (WOSI) score, ranging from 0 (best possible) to 2100. The between-group minimal clinically important difference at 12 weeks was 250 points. Secondary outcomes included WOSI subdomain scores, patient-reported ratings of kinesiophobia and pain, objective shoulder function, patient satisfaction, and number of adverse events.Results: The between-group mean difference in the WOSI total score at 12 weeks significantly favored SINEX over HOMEX ). SINEX was furthermore superior to HOMEX in most of the secondary outcomes (3/4 subdomains of the WOSI and pain level during the past 7 days as well as clinical signs of anterior shoulder instability). Also, although not statistically significant, less than half the proportion of the SINEX patients compared with the HOMEX patients (3/27 [11%] vs 6/24 [25%], respectively; P ¼ .204) underwent or were referred for shoulder stabilizing surgery. Satisfaction with both exercise programs was high, and no serious adverse events were reported.Conclusion: Neuromuscular shoulder exercise (SINEX) was superior to standard care exercise (HOMEX) in patients with traumatic ASDs. Further long-term follow-ups on treatment effects are needed.Registration: NCT02371928 (ClinicalTrials.gov identifier).A traumatic anterior shoulder dislocation (ASD) is a common athletic injury among young, active patients. 34 The annual incidence of primary traumatic ASDs is between 11.2 and 26.2 per 100,000 people. 30,32,52 Patients with primary traumatic ASDs are prone to recurrent ASDs because

show abstract

“…Age and gender are the most important prognostic factors predicting recurrence, with young men at greatest risk (Owens et al, 2009a). Three-quarters of male athletes under 25 years will develop recurrent instability by 2 years, rising to 85% at 5 years (Table 1; Robinson et al, 2006). This high rate of recurrence in adolescents is independent of proximal humeral physis closure (Postacchini et al, 2000).…”

Section: Who Is At Risk?mentioning

confidence: 99%

“…However, youth is also a marker for early return to competitive sport, noncompliance with rehabilitation and more significant capsulolabral avulsion at original dislocation, which all increase the risk of recurrence (Balg & Boileau, 2007). Other factors associated with recurrence include GLL and participation in high-level sport (Robinson et al, 2006). A more gradual return to play in these groups may be warranted to prevent future injury and recurrent instability.…”

Section: Who Is At Risk?mentioning

confidence: 99%

Traumatic anterior shoulder instability in the athlete

Murray

Ahmed

White

et al. 2012

Scandinavian Med Sci Sports

View full text Add to dashboard Cite

Anterior glenohumeral dislocation is common among athletes and may progress to recurrent instability. The pathoanatomy of instability and specific needs of each individual should be considered to prevent unnecessary absence from sport. Traditionally, primary dislocations have been managed with immobilization followed by rehabilitation exercises and a return to sporting activity. However, arthroscopic stabilization and external rotation bracing are increasingly used to prevent recurrent instability. In addition to the typical capsulolabral disruptions seen following a primary dislocation, patients with recurrent instability often have coexistent osseous injury to the humeral head and glenoid. In patients without significant bone loss, open soft‐tissue stabilizations have long been considered the ‘gold standard treatment’ for recurrent instability, but with advances in technology, arthroscopic procedures have gained popularity. However, enthusiasm for arthroscopic repair has not been supported with evidence, and there is currently no consensus for treatment. In patients with greater bone loss, soft‐tissue stabilization alone is insufficient to treat recurrent instability and open repair or bone augmentation should be considered. We explore the recent advances in epidemiology, classification, pathoanatomy and clinical assessment of young athletes with anterior shoulder instability, and compare the relative merits and outcomes of the different forms of treatment.

show abstract

Functional Outcome and Risk of Recurrent Instability After Primary Traumatic Anterior Shoulder Dislocation in Young Patients

Cited by 149 publications

References 35 publications

Mid-term to long-term results of primary arthroscopic Bankart repair for traumatic anterior shoulder instability: a retrospective study

Mid-term to long-term results of primary arthroscopic Bankart repair for traumatic anterior shoulder instability: a retrospective study

Neuromuscular Exercises Improve Shoulder Function More Than Standard Care Exercises in Patients With a Traumatic Anterior Shoulder Dislocation: A Randomized Controlled Trial

Traumatic anterior shoulder instability in the athlete

Contact Info

Product

Resources

About