Two-center RCT of 40 patients under age 30 randomized to immediate arthroscopic stabilization versus 3-week immobilization plus rehabilitation after first traumatic anterior shoulder dislocation. This paper reports long-term outcomes at mean 79-month follow-up, extending earlier 32-month data from the same cohort. The central question: does early surgery produce lasting benefits in quality of life and recurrence compared to a structured wait-and-see approach?
A young patient under 30 comes in after a first anterior dislocation, and the reflex is to operate — historical recurrence rates of 17%-96% make that instinct understandable.
This trial argues for a more selective approach. When you apply intention-to-treat logic, 12 of 19 nonoperative patients never needed surgery, and their long-term ASES and DASH scores were essentially identical to those who had immediate stabilization.
Where immediate surgery earns its place: high-level athletes in sports where a second dislocation carries serious or life-threatening consequence. White-water kayaking, rock climbing, parachuting, rugby. For these patients, the risk asymmetry justifies operating after the first event. For everyone else, counsel patients that roughly 60% will never redislocate, and those who do can be salvaged with delayed stabilization.
The WOSI's persistent 11.5% gap (above the 10.4% MCID) is a methodologic lesson as much as a clinical one: global tools like ASES and DASH can miss real patient-felt disability in instability populations. Use disease-specific instruments when evaluating these outcomes.
Two-center RCT of 40 patients under age 30 randomized to immediate arthroscopic stabilization versus 3-week immobilization plus rehabilitation after first traumatic anterior shoulder dislocation. This paper reports long-term outcomes at mean 79-month follow-up, extending earlier 32-month data from the same cohort. The central question: does early surgery produce lasting benefits in quality of life and recurrence compared to a structured wait-and-see approach?
A young patient under 30 comes in after a first anterior dislocation, and the reflex is to operate — historical recurrence rates of 17%-96% make that instinct understandable.
This trial argues for a more selective approach. When you apply intention-to-treat logic, 12 of 19 nonoperative patients never needed surgery, and their long-term ASES and DASH scores were essentially identical to those who had immediate stabilization.
Where immediate surgery earns its place: high-level athletes in sports where a second dislocation carries serious or life-threatening consequence. White-water kayaking, rock climbing, parachuting, rugby. For these patients, the risk asymmetry justifies operating after the first event. For everyone else, counsel patients that roughly 60% will never redislocate, and those who do can be salvaged with delayed stabilization.
The WOSI's persistent 11.5% gap (above the 10.4% MCID) is a methodologic lesson as much as a clinical one: global tools like ASES and DASH can miss real patient-felt disability in instability populations. Use disease-specific instruments when evaluating these outcomes.