Young, athletic, first-time shoulder dislocation patients benefit from arthroscopic surgery long term, according to a study released today at the 2008 American Orthopaedic Society for Sports Medicine Specialty Day. The study found that for highly active patients, surgery, rather than conservative methods, yielded excellent results. In young, active patients, there were statistics as high as 92 percent that they would dislocate their shoulder again when conservative approaches like rest and immobilization in a sling were used. If we had an operation with a 90 percent failure rate, we would abandon the procedure.
Why should we embrace a treatment with such a high failure rate?
Beginning in 1993, the researchers began performing arthroscopic surgery on young military cadets who suffered their first shoulder dislocation. The short-term results were excellent. The unknown, however, was how these patients would fare over the years. They examined these patients’ long-term results and found that these patients maintained their health and active lifestyle. Surgery for this group of patients was durable and provided excellent shoulder function and a high activity level even after 10 years. They evaluated 39 patients (40 shoulder operations) whose follow-up averaged 11.7 years. Patients were evaluated with patient-derived outcomes measures and asked to compare their repaired shoulder to its function level pre-injury and whether they would be likely to have the surgery again. Additionally, they were physically assessed with a number of tests, including, how many push-ups they completed in two minutes and performance on the Army Physical Fitness Test. Overall, the study found that the patients maintained excellent use of their shoulder. The mean American Shoulder and Elbow Surgeons score was 90.9. The patients compared their repaired shoulders’ function to the pre-injury function. The average response was 93 percent, the study found. When responding to whether they would have the surgery again with 10 being “very likely,” the average score was 9.1, according to the study. In terms of athletic ability, the results were also notable. The study found the average number of push-ups performed in 2 minutes was 72.8 compared to 77.7 prior to their injuries. The mean score of the Army Physical Fitness Test was 282.2 out of a possible 300, according to the study. The study also noted five patients who had eight further dislocations, all of which occurred during athletic activity, for a failure rate of 10 percent long-term. Certainly the study proves that for this group of patients, young, athletic cadets unable to modify their activity level, arthroscopic surgery for first-time dislocations is successful both short and long-term. This treatment allowed our patients to return to sports, graduate from the military academy and engage in active duty military obligations. It may not be the approach that should be taken for a person who lives a sedentary lifestyle, but this could be applicable to the young, 15-25-year-old athlete, who is at high risk for recurrent instability and compromised function.
Some patients may be appropriate for nonoperative treatment of shoulder dislocations. Newer methods of immobilization seem to offer a lower recurrence rate of dislocations. In 2003, researchers found that immobilizing the dislocated shoulder in a position of external rotation significantly reduces the rate of recurrent dislocations in first time dislocations. Below is one of my patients in the Don Joy ER brace.
Below is an arthroscopic view of a post dislocation Bankart lesion (tear of the anterior labrum).
Here is one of my cases of a Bankart lesion of the anterior labrum being repaired arthroscopically. The anchors are embedded in the bone and the sutures have been passed around the labrum.
Below the sutures have been tied and the anterior glenoid labrum have been repaired arthroscopically.
To help you understand further, below is a diagram of what we do. It’s from my website at www.OrthoOnTheWeb.com.
Thanks.
JTM, MD