Sachs, J Bone Joint Surg Am 2007 - Can the Need for Future Surgery for Acute Traumatic Anterior Shoulder Dislocation Be Predicted?

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Can the Need for Future Surgery for Acute Traumatic Anterior Shoulder Dislocation Be Predicted?

Sachs, Kuney, et al.·J Bone Joint Surg Am·2007·169 citations·Prospective cohort

Background

Some surgeons believe that they can identify patients who are at high risk for shoulder redislocation and that these patients are best served by immediate surgical stabilization. This natural history study was performed to examine the validity of this concept and to determine whether it is possible to predict the need for future surgery at the time of the index injury and examination.

Methods

131 patients were followed for an average of 4 years after their first shoulder dislocation.
An extensive history was recorded and a thorough physical examination was performed on each patient.
Final evaluation consisted of a physical examination, radiographic evaluation, and determination of 3 outcome measurements.

Results

29 (22%) of the 131 patients requested surgery during the follow-up period.
There were 20 Bankart repairs and 9 rotator cuff repairs.
43 patients (33%) had at least one recurrent dislocation.
39 of these patients were in the group of 90 patients under the age of 40 years.
37 of these 39 patients either participated in contact or collision sports or used the arm at or above chest level in their occupation.
18 (49%) of these 37 patients had surgery.
Only 2 of the more sedentary patients had redislocation, and none had surgery.
4 (10%) of the 41 patients over the age of 40 had a redislocation, but none required a Bankart repair.
However, 8 (20%) of the 41 patients required a rotator cuff repair.
88 (67%) of the 131 patients never had a redislocation.
Their outcome scores were high and equivalent to those of the cohort of patients who had had a successful Bankart repair of an unstable shoulder.
Patients who had redislocation but chose to cope with the instability rather than have surgery had lower outcome scores.
22 (51%) of the 43 patients who had recurrent instability had only one redislocation during the entire follow-up period, whereas some patients had as many as 12 complete redislocations.

Conclusions

Younger patients involved in contact or collision sports or who require overhead occupational use of the arm are more likely to have a redislocation of the shoulder than are their less active peers or older persons. However, even in the highest-risk groups, only approximately half of patients with shoulder redislocation requested surgery within the follow-up period. Early surgery based on the presumption of future dislocations, unhappiness, and disability cannot be justified.

Copyright remains with the authors and publisher.

Can the Need for Future Surgery for Acute Traumatic Anterior Shoulder Dislocation Be Predicted?

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Can the Need for Future Surgery for Acute Traumatic Anterior Shoulder Dislocation Be Predicted?

Sachs, Kuney, et al.·J Bone Joint Surg Am·2007·169 citations·Prospective cohort

Background

Some surgeons believe that they can identify patients who are at high risk for shoulder redislocation and that these patients are best served by immediate surgical stabilization. This natural history study was performed to examine the validity of this concept and to determine whether it is possible to predict the need for future surgery at the time of the index injury and examination.

Methods

131 patients were followed for an average of 4 years after their first shoulder dislocation.
An extensive history was recorded and a thorough physical examination was performed on each patient.
Final evaluation consisted of a physical examination, radiographic evaluation, and determination of 3 outcome measurements.

Results

29 (22%) of the 131 patients requested surgery during the follow-up period.
There were 20 Bankart repairs and 9 rotator cuff repairs.
43 patients (33%) had at least one recurrent dislocation.
39 of these patients were in the group of 90 patients under the age of 40 years.
37 of these 39 patients either participated in contact or collision sports or used the arm at or above chest level in their occupation.
18 (49%) of these 37 patients had surgery.
Only 2 of the more sedentary patients had redislocation, and none had surgery.
4 (10%) of the 41 patients over the age of 40 had a redislocation, but none required a Bankart repair.
However, 8 (20%) of the 41 patients required a rotator cuff repair.
88 (67%) of the 131 patients never had a redislocation.
Their outcome scores were high and equivalent to those of the cohort of patients who had had a successful Bankart repair of an unstable shoulder.
Patients who had redislocation but chose to cope with the instability rather than have surgery had lower outcome scores.
22 (51%) of the 43 patients who had recurrent instability had only one redislocation during the entire follow-up period, whereas some patients had as many as 12 complete redislocations.

Conclusions

Younger patients involved in contact or collision sports or who require overhead occupational use of the arm are more likely to have a redislocation of the shoulder than are their less active peers or older persons. However, even in the highest-risk groups, only approximately half of patients with shoulder redislocation requested surgery within the follow-up period. Early surgery based on the presumption of future dislocations, unhappiness, and disability cannot be justified.

Copyright remains with the authors and publisher.

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