The natural history of primary anterior dislocation of the glenohumeral joint in adolescence

Abstract

The natural history of primary anterior dislocation of the glenohumeral joint in adolescent patients remains unclear and there is no consensus for management of these patients. The objectives of this study were to report the natural history of primary anterior dislocation of the glenohumeral joint in adolescent patients and to identify the risk factors for recurrent dislocation. We reviewed prospectively-collected clinical and radiological data on 133 adolescent patients diagnosed with a primary anterior dislocation of the glenohumeral joint who had been managed non-operatively at our hospital between 1996 and 2008. There were 115 male (86.5%) and 18 female patients (13.5%) with a mean age of 16.3 years (13 to 18) and a mean follow-up of 95.2 months (1 to 215). During follow-up, 102 (absolute incidence of 76.7%) patients had a recurrent dislocation. The median interval between primary and recurrent dislocation was ten months (95% CI 7.4 to 12.6). Applying survival analysis the likelihood of having a stable shoulder one year after the initial injury was 59% (95% CI 51.2 to 66.8), 38% (95% CI 30.2 to 45.8%) after two years, 21% (95% CI 13.2 to 28.8) after five years, and 7% (95% CI 1.1 to 12.9) after ten years. Neither age nor gender significantly predicted recurrent dislocation during follow-up. We conclude that adolescent patients with a primary anterior dislocation of the glenohumeral joint have a high rate of recurrent dislocation, which usually occurs within two years of their initial injury: these patients should be considered for early operative stabilisation.

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.…”

“…Patient demographic factors, including age and involvement in competitive athletics, particularly contact sports, are known to predispose patients to recurrent shoulder instability after nonoperative and arthroscopic management. 1,4,10,11 In addition, instability-related intra-articular pathology may increase the risk of inferior outcomes after initial treatment, including labral tears, glenoid bone loss, Hill-Sachs lesions, capsular injuries such as humeral avulsion of the glenohumeral ligament (HAGL) lesions, anterior labral periosteal sleeve avulsion (ALPSA) lesions, and rotator cuff tears. [10][11][12][14][15][16][17][18] Osseous deficiency has been increasingly recognized as a significant risk factor for compromised outcomes after nonoperative and arthroscopic treatment of shoulder instability.…”

Recurrence and return to play after shoulder instability events in young and adolescent athletes: a systematic review and meta-analysis

“…In Lampert et al ,18 the follow-up period was 12 months, which was particularly short in comparison to other studies reporting data in patients aged <14 years. For example, the studies reporting the highest rates including Marans et al (78 months), Roberts et al (95.2 months) and Wagner et al (75 months), all had significantly greater average follow-up periods 28 30 33. While other studies have generally noted the risk of recurrence to be particularly high in the first 1–2 years after the primary instability event, such results have typically been based on study populations of age 16 years and older.…”

The Epidemiology and Natural History of Anterior Shoulder Instability

“…One hundred two patients (76.7%) had a recurrent dislocation. The incidence of recurrent shoulder instability was 59, 38, 21, and 7% at 1-, 2-, 5-, and 10-year follow-up, respectively [82]. The authors advocate for early operative intervention in adolescents due to the high recurrence rates with nonoperative treatment.…”