A Prospective, Randomized Evaluation of Arthroscopic Stabilization Versus Nonoperative Treatment in Patients with Acute, Traumatic, First-Time Shoulder Dislocations (original) (raw)
Related papers
Arthroscopic stabilization of anterior shoulder instability: A historical perspective
Bulletin (Hospital for Joint Diseases (New York, N.Y.))
The treatment of anterior glenohumeral instability has been a topic of debate in the recent literature. Current surgical management of shoulder instability has included a variety of open and arthroscopic procedures. Open techniques for anterior reconstruction have been quite successful in preventing recurrent dislocations and continue to be the gold standard of care. In an attempt to address some of the disadvantages associated with open procedures, arthroscopic stabilization procedures have been developed. Arthroscopic capsuloligamentous repair presumably has clear advantages including better cosmesis, decreased perioperative morbidity, and a possible decrease in the loss of external rotation. Advances in arthroscopic instrumentation and improved arthroscopic techniques have increased the popularity of arthroscopic stabilization. The art of diagnosing the anatomic pathology associated with instability and proper patient selection continues to evolve. Most previous reports of arthroscopic stabilization have included small numbers of patients, variable patient pathology, and a variety of surgical techniques, making comparisons between stabilization procedures difficult. Arthroscopy can be valuable in both the confirmation of the degree and severity of the instability and to correct the pathoanatomy responsible for the instability.
Arthroscopic Stabilization for First-Time Versus Recurrent Shoulder Instability
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2010
Purpose: The purpose of this study was to systematically review the evidence on the outcomes of arthroscopic repair for anterior shoulder instability in first-time dislocators when compared with patients with recurrent instability. Methods: We designed a systematic review with a specific methodology to investigate the outcomes of surgery for those with only a first-time dislocation versus those who underwent surgery after multiple instability events. We performed a literature search from January 1966 to December 2008 using Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials. Key words included the following: first time, primary shoulder, or recurrent shoulder instability, shoulder dislocation, Bankart repair, arthroscopic Bankart repair, and labral repair. The inclusion criteria were cohort studies (Level I to II) that evaluated the outcomes of patients undergoing arthroscopic stabilization after the first dislocation or multiple recurrent episodes. Studies that lacked a comparison group or were retrospective (Level III studies or higher) were excluded. Results: There were 15 studies that met the inclusion criteria and were included in the final analysis: 5 in the first-time dislocation group and 10 in the recurrent instability group. Study design, patient demographics, mean number of dislocations, surgical technique, and rehabilitation protocol, as well as subjective and objective outcome measures, were recorded. Conclusions: There were no differences in recurrence or complication rate among patients undergoing surgery after the primary dislocation when compared with those undergoing surgery after multiple recurrent episodes. Clinical outcome measures significantly improved within all independent studies from preoperatively to postoperatively. However, because of variation in the outcome measurement tools used, no direct comparison between the study groups could be performed. Additional randomized controlled studies are needed to compare the functional outcome, quality of life, and ability to return to preinjury activity level among patients undergoing early versus delayed repair for anterior shoulder instability. Level of Evidence: Level II, systematic review of Level I and II studies.
Criteria for arthroscopic treatment of anterior instability of the shoulder
Journal of Bone and Joint Surgery- …, 2005
We prospectively evaluated 61 patients treated arthroscopically for anterior instability of the shoulder at a mean follow-up of 44.5 months (24 to 100) using the Rowe scale. Those with post-operative dislocation or subluxation were considered to be failures. Logistic regression analysis was used to identify patients at increased risk of recurrence in order to develop a suitable selection system. The mean Rowe score improved from 45 pre-operatively to 86 at follow-up (p < 0.001). At least one episode of post-operative instability occurred in 11 patients (18%), although their stability improved (p = 0.018), and only three required revision. Subjectively, eight patients were dissatisfied. Age younger than 28 years, ligamentous laxity, the presence of a fracture of the glenoid rim involving more than 15% of the articular surface, and post-operative participation in contact or overhead sports were associated with a higher risk of recurrence, and scored 1, 1, 5 and 1 point, respectively. Those patients with a total score of two or more points had a relative risk of recurrence of 43% and should be treated by open surgery.
Current Medical Research, 2022
Background: Shoulder dislocations are frequent orthopedic injuries encountered in emergency services. Increasing the arthroscopic experience of physicians and developing technology has left the place of open surgical repair to arthroscopic reconstruction procedures. This study aimed to examine the results of arthroscopic reconstruction procedures for anterior and posterior shoulder instability. Methods: In this study, 89 patients diagnosed with shoulder instability and treated arthroscopically in our clinic between January 1, 2013, and September 1, 2020, postoperative range of motion and functional results are evaluated with Rowe and WOSI scores. Results: Fifty-seven of 89 patients had anterior, and 32 patients had posterior glenohumeral instabilities. In our study, 14 patients (15.7%) were under 20 years old, 55 patients (61.8%) between 21-30 years, 16 patients (18.0%) between 31-40 years, and 4 patients (4.5%) over 40 years. A total of 72 males (80.9%) were included in the study, with 17 females (19.1%). In the postoperative period, the mean shoulder joint flexion of all patients was recorded as 166.6 degrees, internal rotation 79.8 degrees, and external rotation was 79.9 degrees. The mean preoperative total WOSI score of all patients was 1062.6, whereas this score was 150.7 postoperatively. According to the Rowe score, there were poor results in all patients in the preoperative period, whereas the Rowe score of 70 patients was excellent; three patients were good, 11 patients were moderate, and five patients were poor in the postoperative period. Conclusions: Arthroscopic treatment of glenohumeral instability could provide predictable success in unidirectional shoulder instability.
Controversies in the Surgical Management of Shoulder Instability: Open vs Arthroscopic Procedures
The Open Orthopaedics Journal, 2017
Background:Traumatic anterior instability of the shoulder is a common condition associated with a high recurrence rate in young adults. Operative treatment reduces the risk of recurrence. Several studies have compared arthroscopic and open shoulder instability repair. The purpose of this paper is to perform a review of the literature where both techniques are compared in the repair of the anterior shoulder instability without bone loss.Methods:Prior to arthroscopy, recurrent dislocations were managed by open repair. There have been many studies documenting low recurrence rates after open Bankart stabilization.Initially, arthroscopic fixation reported high failure rates.Results:In the last 20 years, the development of arthroscopic stabilization for recurrent anterior instability has improved failure rates. In comparison with open techniques, arthroscopic procedures have the advantages of decreased morbidity rate, early functional rehabilitation and improved range of motion.Conclusion...
The effectiveness of arthroscopic stabilisation for failed open shoulder instability surgery
The Bone & Joint Journal
We identified ten patients who underwent arthroscopic revision of anterior shoulder stabilisation between 1999 and 2005. Their results were compared with 15 patients, matched for age and gender, who had a primary arthroscopic stabilisation during the same period. At a mean follow-up of 37 and 36 months, respectively, the scores for pain and shoulder function improved significantly between the pre-operative and follow-up visits in both groups (p = 0.002), with no significant difference between them (p = 0.4). The UCLA and Rowe shoulder scores improved significantly (p = 0.004 and p = 0.002, respectively), with no statistically significant differences between groups (p = 0.6). Kaplan-Meier analysis for time to recurrent instability showed no differences between the groups (p = 0.2). These results suggest that arthroscopic revision anterior shoulder stabilisation is as reliable as primary arthroscopic stabilisation for patients who have had previous open surgery for recurrent anterior ...
Yonsei Medical Journal, 2010
Acute anterior dislocation of the shoulder is reported to be commonly prevalent in athletes, and its treatment method and protocol are still debated. For early conservative management of its instability, duration and posture of fixation and method of physical therapy are not clearly defined. Conventionally, the shoulder is fixed in an internally rotated position for 3 to 6 weeks. However, recently, there have been reports to fix the externally rotated position to limit recurrence. 1 There have been reports of various results in the conservative management of acute anterior dislocation of the shoulder. 2-6 The authors thought that other than the generally known Bankart lesion, these lesions lead to various outcomes. Therefore, the authors studied young and active patients with anterior dislocation of the shoulder for the first time to investigate and analyze anteroinferior labrum injury types, including accompanying lesions in acute anterior dislocation of the
Arthroscopic treatment of shoulder instability: current concepts and techniques
Surgical technology international, 1999
Background: Post-traumatic shoulder instability is a common disease, especially in sportsmen. If inadequately or late treated, it may be responsible for an articular biomechanics alteration, with serious problems. This is much more obvious for professionals athletes, because corporate and market needs force them to a premature return to sport. The purpose of this retrospective study is to evaluate if arthroscopic approach may be better than the open one and allowing a shoulder function rapid recovery, with fast return to sport. Materials and methods: From January 2003 to January 2014, 46 professional athletes underwent surgical treatment for post traumatic shoulder instability. Two groups were made: 25 athletes treated arthroscopically and 21 treated with open approach. Patients were followed up from 36 to 92 months, according to Rowe Score for Instability and VAS scoring system. Results: Patients in the open group returned later than the first one to sport. Moreover, pain in postoperative period and during rehabilitation, was lower in the arthroscopic group. There was only one recurrence in the open group. Conclusions: Arthroscopic surgical approach appears to be excellent in shoulder instability management, reducing recovery time, allowing a faster return to sport, with less pain, if compared with open surgery. Level of Evidence: III, a case control-study.
Rationales of arthroscopic shoulder stabilization
Archives of orthopaedic and trauma surgery, 2002
Arthroscopic reconstruction of glenohumeral instability has become more common during the past decade. Compared with open reconstruction, which is still the gold standard in the treatment of shoulder instability, arthroscopic techniques allow for improved diagnosis of numerous intraarticular findings. This review presents an appropriate system for the arthroscopic classification of most pathological findings in patients with anterior shoulder instability. Based on the presented classification, a rationale for arthroscopic reconstruction under special conditions is given. Several operative techniques and implants are discussed and their use in certain circumstances analyzed. Special emphasis is targeted on techniques of realizing sufficient capsular shift or plication. Arthroscopic procedures remain technically demanding and require skills to address the great variety of possible situations. On the other hand, arthroscopic techniques in shoulder reconstruction benefit patients by avo...