Kirkley, Arthroscopy 2005 - Prospective Randomized Clinical Trial Comparing the Effectiveness of Immediate Arthroscopic Stabilization versus Immobilization and Rehabilitation in First Traumatic Anterior Dislocations of the Shoulder: Long-Term Evaluation
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Prospective Randomized Clinical Trial Comparing the Effectiveness of Immediate Arthroscopic Stabilization versus Immobilization and Rehabilitation in First Traumatic Anterior Dislocations of the Shoulder: Long-Term Evaluation
Kirkley, Griffin, et al.·Arthroscopy·2005·535 citations·RCT
Kirkley and colleagues tested whether arthroscopic stabilization performed right after a first‑time traumatic anterior shoulder dislocation gives better long‑term results than immobilization and rehabilitation in patients under 30.
Two‑center randomized trial of 40 patients under 30, with 31 reassessed at a mean of 79 months (range 51 to 102).
The authors hypothesized that immediate stabilization would lower redislocation and improve disease‑specific quality of life, and that a wait‑and‑see approach would worsen long‑term outcome.
Methods
Design
Randomized controlled trial
Long‑term follow‑up of a previously reported cohort
Single‑blinded: a research assistant unaware of group did all evaluations
Setting
2 university centers in Ontario, Canada
Patients
40 randomized
Younger than 30 years
First traumatic anterior dislocation
31 returned long‑term data (16 surgical, 15 traditional)
Groups
Arthroscopic transglenoid suture repair within 4 weeks, then 3 weeks of immobilization and the same rehabilitation
Immobilization for 3 weeks plus the same rehabilitation
Follow-up
Mean 79 months
Earlier report at 32 months
Primary outcome
WOSI (disease‑specific quality of life)
Outcomes
Redislocation
ASES
DASH
Key Findings
Redislocation was significantly less common after surgery: 3 patients in the surgical group vs 9 in the traditional group, with no new dislocations in either group after the 32‑month report.
The WOSI advantage of surgery fell from significant at 32 months (86.3% vs 69.8% of normal, p = 0.03) to not significant at 79 months (86.3% vs 74.8%, p = 0.17, CI −5.8% to 28.7%) as the traditional group improved.
All but 1 patient in each group returned to all or most of their preinjury sport or activities.
The global shoulder scores did not differ between groups at 79 months: ASES was 94.7% vs 93.5% (p = 0.73) and DASH was 95.8% vs 94.1% (p = 0.57).
Only 7 patients in the traditional group ever had stabilization, compared with all 19 in the surgical group, who also had 2 revision operations.
The trial was underpowered for the WOSI, since the authors calculated 48 patients per group were needed and it could detect only a 20% difference.
Board pearl
In patients under 30 with a first traumatic anterior dislocation, immediate arthroscopic stabilization reduced redislocation (3 vs 9 patients), but its quality‑of‑life advantage was no longer significant at 79 months.
Authors' conclusion
It is recommended that immediate arthroscopic stabilization is the treatment of choice in a subset of patients who are younger than 30 years and are higher level athletes, and the timing for surgery is good or their sport is risky, i.e., rugby, football, kayaking, rock climbing.
Prospective Randomized Clinical Trial Comparing the Effectiveness of Immediate Arthroscopic Stabilization versus Immobilization and Rehabilitation in First Traumatic Anterior Dislocations of the Shoulder: Long-Term Evaluation
Kirkley, Griffin, et al.·Arthroscopy·2005·535 citations·RCT
Kirkley and colleagues tested whether arthroscopic stabilization performed right after a first‑time traumatic anterior shoulder dislocation gives better long‑term results than immobilization and rehabilitation in patients under 30.
Two‑center randomized trial of 40 patients under 30, with 31 reassessed at a mean of 79 months (range 51 to 102).
The authors hypothesized that immediate stabilization would lower redislocation and improve disease‑specific quality of life, and that a wait‑and‑see approach would worsen long‑term outcome.
Methods
Design
Randomized controlled trial
Long‑term follow‑up of a previously reported cohort
Single‑blinded: a research assistant unaware of group did all evaluations
Setting
2 university centers in Ontario, Canada
Patients
40 randomized
Younger than 30 years
First traumatic anterior dislocation
31 returned long‑term data (16 surgical, 15 traditional)
Groups
Arthroscopic transglenoid suture repair within 4 weeks, then 3 weeks of immobilization and the same rehabilitation
Immobilization for 3 weeks plus the same rehabilitation
Follow-up
Mean 79 months
Earlier report at 32 months
Primary outcome
WOSI (disease‑specific quality of life)
Outcomes
Redislocation
ASES
DASH
Key Findings
Redislocation was significantly less common after surgery: 3 patients in the surgical group vs 9 in the traditional group, with no new dislocations in either group after the 32‑month report.
The WOSI advantage of surgery fell from significant at 32 months (86.3% vs 69.8% of normal, p = 0.03) to not significant at 79 months (86.3% vs 74.8%, p = 0.17, CI −5.8% to 28.7%) as the traditional group improved.
All but 1 patient in each group returned to all or most of their preinjury sport or activities.
The global shoulder scores did not differ between groups at 79 months: ASES was 94.7% vs 93.5% (p = 0.73) and DASH was 95.8% vs 94.1% (p = 0.57).
Only 7 patients in the traditional group ever had stabilization, compared with all 19 in the surgical group, who also had 2 revision operations.
The trial was underpowered for the WOSI, since the authors calculated 48 patients per group were needed and it could detect only a 20% difference.
Board pearl
In patients under 30 with a first traumatic anterior dislocation, immediate arthroscopic stabilization reduced redislocation (3 vs 9 patients), but its quality‑of‑life advantage was no longer significant at 79 months.
Authors' conclusion
It is recommended that immediate arthroscopic stabilization is the treatment of choice in a subset of patients who are younger than 30 years and are higher level athletes, and the timing for surgery is good or their sport is risky, i.e., rugby, football, kayaking, rock climbing.