Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial

Abstract

Background: Treatment of first-time shoulder dislocation (FSD) is a topic of debate. After high rates of recurrent instability after nonoperative management were reported in the literature, primary repair of FSD significantly increased. At the same time, new concepts were proposed that had promising results for immobilization in external rotation (ER) and abduction (ABD). Purpose: The aim of this study was to evaluate the recurrence rates (primary outcome) and clinical outcomes (secondary outcome parameters) of immobilization in ER+ABD versus arthroscopic primary stabilization after FSD. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In a multicenter randomized controlled trial, patients with FSD were randomized to either treatment with immobilization in 60° of ER plus 30° of ABD (group 1) or surgical treatment with arthroscopic Bankart repair (group 2). Clinical evaluation was performed 1, 3, and 6 weeks as well as 6, 12, and 24 months postoperatively or after reduction, including range of motion, instability testing, subjective shoulder value, Constant-Murley score, Rowe score, and Western Ontario Shoulder Instability Index. Recurrent instability events were prospectively recorded. Results: Between 2011 and 2017, a total of 112 patients were included in this study. Of these, 60 patients were allocated to group 1 and 52 to group 2. At the 24-month follow-up, 91 patients (81.3%) were available for clinical examination. The recurrence rate was 19.1% in group 1 and 2.3% in group 2 ( P = .016). No significant differences were found between groups regarding clinical shoulder scores ( P > .05). Due to noncompliance with the immobilization treatment protocol, 4 patients (6.7%) were excluded. Conclusion: Immobilization in ER+ABD versus primary arthroscopic shoulder stabilization for the treatment of FSD showed no differences in clinical shoulder scores. However, recurrent instability was significantly higher after nonoperative treatment.

A 2-Year Follow-up May Not be Enough to Accurately Evaluate Recurrences After Arthroscopic Bankart Repair: A Long-term Assessment of 272 Patients With a Mean Follow-up of 10.5 Years

“…14 However, the results regarding its ability to prevent recurrences in the long term are more controversial, and there is enormous variability in the percentage of recurrences reported depending on the follow-up time in the studies evaluated. 17,18,23,31 Recently, 2 randomized controlled trials published in 2021 reported 2% and 10% recurrence rates after arthroscopic Bankart repair at 24 months of follow-up. 17,23 Moreover, a recent systematic review reported a 6.5% recurrence rate after 3 years of follow-up with arthroscopic Bankart repair.…”

old anterior dislocation of the shoulder joint : a rare case report and literature review

“…There is no consensus on the method of repositioning, with Kocher's method recommended, foot stirrups not recommended, and brachial plexus anaesthesia or intraarticular local anaesthesia for repositioning in elderly patients with osteoporosis. There is also no agreement on the type of braking and there is still discussion on whether to immobilise the shoulder joint in internal or external rotation [9][10][11]. A study has reported no difference between these two types of braking in terms of recurrence rates and healing outcomes of joint dislocation and return to activity levels [12].…”

Case report of old anterior dislocation of the shoulder joint and review of the literature

“…There is no consensus on the method of repositioning, with Kocher's method recommended, foot stirrups not recommended, and brachial plexus anaesthesia or intra-articular local anaesthesia for repositioning in elderly patients with osteoporosis. There is also no agreement on the type of braking and there is still discussion on whether to immobilise the shoulder joint in internal or external rotation (9)(10)(11). A study has reported no difference between these two types of braking in terms of recurrence rates and healing outcomes of joint dislocation and return to activity levels (12).…”