Primary Arthroscopic Stabilization for a First-Time Anterior Dislocation of the Shoulder

Abstract

Background: The aim of this study was to evaluate the long-term efficacy of arthroscopic Bankart repair (ABR). Methods: Eighty-eight patients with an age of ≤35 years who had sustained a primary anterior glenohumeral dislocation were enrolled in a single-center, double-blinded clinical trial. Subjects were randomized to receive either an arthroscopic washout (AWO) or ABR. Participants were reassessed after a minimum of 10 years postoperatively. Data regarding recurrent instability, revision surgery, satisfaction, and function (Disabilities of the Arm, Shoulder and Hand [DASH] and Western Ontario Shoulder Instability Index [WOSI]) scores were collected. Results: Sixty-five patients (74%; 32 in the AWO group and 33 in the ABR group) were included and had an average follow-up of 14.2 years (range,12 to 16 years). The rate of recurrent dislocation was significantly higher in the AWO group than the ABR group (47% and 12%, respectively; p = 0.002). Kaplan-Meier curves were plotted for event-free survival using recurrent instability and/or revision surgery as clinical end points. This analysis demonstrated a sustained significant difference between the groups at 10 years after surgery (58% for the AWO group versus 79% for the ABR group; log-rank test [Mantel-Cox]; p = 0.018). Long-term WOSI scores were significantly better in the ABR group. The presence of recurrent instability was associated with significantly poorer WOSI and DASH scores. Conclusions: This study demonstrates a long-term benefit in overall shoulder stability and functional outcome in high-risk patients who have undergone ABR for first-time anterior dislocation. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

“…Moore et al 21 34 DS 1 (3) 2 (6) (9) Yapp et al 62 32 DS 4 (12) 3 (9) 7 (21) Rhee et al 63 48 DS requiring revision surgery 1 (2) 3 (6) (2) Oh et al 64 120 Dislocation or positive apprehension 12 (10) 14 (12)…”

“…Definition of dislocation Dislocation needing reduction (by medical professional or third party) 12,16,19,26,31,33,34,37,57,58,68,70,[72][73][74]87,91,102 Objective documentation of a dislocation either radiologically or clinically 24,32,59,62,71,75,92 Increased translation of the humerus relative to the glenoid to the point of complete separation of articular surfaces 96 More than 1 episode of instability which needed manual reduction by other people 97…”

“…Instability without the need of reduction 12,13,16,26,31,33,34,45,57,58,68,70,72,87,91,97,102 Subjective sense of subluxation/instability 24,37,44,60,69,71,99 Sense of dislocation with a positive anterior apprehension test 59 Transient instability event that did not require reduction but demonstrated a positive apprehension and relocation sign with radiographic or magnetic resonance imaging evidence of a Bankart or Hill-Sachs 19 Symptomatic self-reported subluxation 62 "Dead-arm" phenomenon or instability which spontaneously reduced 73,75 Symptomatic translation of the humeral head relative to the glenoid articular surface without a dislocation 96 Subluxation at the time of the clinical assessment or through a history of at least 1 episode of dead arm syndrome 84 with signs of a sustained dislocation in further radiographs, such as Hill-Sachs or bony Bankart lesion in comparison with the preoperative situation, could be categorized as a confirmed dislocation. For subluxations, we advise using the definition of the feeling of a dislocation that can be (spontaneously) reduced without the need for a radiographically confirmed dislocation.…”

Assessment and management of shoulder dislocation

“…Participation in contact sports, such as rugby, football, basketball, and hockey increases the risk of recurrence. Operative treatment may be preferred in these patients and in younger patients (<40 years) to reduce recurrence 3637. A systematic review (17 studies, 642 patients) evaluating return to sport in athletes aged ≤18 years showed that 41% return to sport (return to pre-injury level or higher) following physical therapy and 95% return to sport following operative treatment 38…”

Short-term outcomes after knotless all-suture anchor Bankart repair

“…Arthroscopic treatment has become the gold standard therapy for symptomatic anterior shoulder instability, offering good clinical results and high return-tosport rates [14,25]. One remaining area of concern is the high recurrence rate of up to 25% that was found to be associated with younger age and the number of anchors used for the fixation of the capsulolabral structures [1,3,17,19,22].…”