Taylor, Am J Sports Med 1997 - Pathologic Changes Associated with Shoulder Dislocations. Arthroscopic and Physical Examination Findings in First-Time, Traumatic Anterior Dislocations
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Pathologic Changes Associated with Shoulder Dislocations. Arthroscopic and Physical Examination Findings in First-Time, Traumatic Anterior Dislocations
Taylor and Arciero recorded which lesions arthroscopy shows soon after a first‑time traumatic anterior shoulder dislocation in young patients, to clarify the essential lesion behind recurrent instability.
Prospective observational study at West Point of patients under 24: 63 chose arthroscopy within 10 days and 53 chose nonoperative care.
Methods
Design
Prospective observational study, June 1986 to September 1994
Patients chose their own treatment
Data source
Keller Army Community Hospital, West Point, New York
Prior instability, impingement or nerve injury excluded
Arthroscopic group: mean age 19.6, 59 men and 4 women
Nonoperative group: mean age 19.1, 52 men and 1 woman
Exposure
Examination under anesthesia and arthroscopy within 10 days of dislocation (63 patients)
Nonoperative care with 4 weeks of immobilization, rehabilitation and no sport for 4 months (53 patients)
Follow-up
More than 2 years in the nonoperative group
Outcomes
Lesions seen at arthroscopy, judged by gross appearance without biopsy
Load‑shift translation graded by the Hawkins system
Recurrent instability in the nonoperative group
Key Findings
All 63 shoulders had a hemarthrosis, and 61 (97%) had a complete Perthes‑Bankart avulsion of the capsulolabral complex (Baker Type III) with no gross intracapsular injury.
Recurrent instability developed in 48 of the 53 patients (90%) who chose nonoperative treatment.
Every shoulder dislocated anteriorly on the load‑shift test under anesthesia (31 reduced on their own and 32 stayed out), although 62 of 63 showed no gross capsular injury.
Of the two shoulders without a Bankart lesion, one had a humeral avulsion of the glenohumeral ligament (HAGL) and the other had an interstitial capsular tear beside an intact labrum (Baker Type I).
Hill‑Sachs lesions were present in 57 shoulders (23 chondral, 34 osteochondral), none were large, and none appeared to affect stability at arthroscopy.
West Point views showed a glenoid rim fracture in 14 of 63 patients (22%), each confirmed at arthroscopy, and no shoulder had a rotator cuff tear.
Board pearl
In patients under 24 after a first‑time traumatic anterior dislocation, arthroscopy found a Perthes‑Bankart avulsion in 97%, and 90% of the separate group managed nonoperatively developed recurrent instability.
Authors' conclusion
In this population, the capsulolabral avulsion appeared to be the primary gross pathologic lesion after a first-time dislocation. These findings, associated with the 90% nonoperative recurrence rate, suggest a strong association between recurrent instability and the Perthes-Bankart lesion in this population.
Taylor and Arciero recorded which lesions arthroscopy shows soon after a first‑time traumatic anterior shoulder dislocation in young patients, to clarify the essential lesion behind recurrent instability.
Prospective observational study at West Point of patients under 24: 63 chose arthroscopy within 10 days and 53 chose nonoperative care.
Methods
Design
Prospective observational study, June 1986 to September 1994
Patients chose their own treatment
Data source
Keller Army Community Hospital, West Point, New York
Prior instability, impingement or nerve injury excluded
Arthroscopic group: mean age 19.6, 59 men and 4 women
Nonoperative group: mean age 19.1, 52 men and 1 woman
Exposure
Examination under anesthesia and arthroscopy within 10 days of dislocation (63 patients)
Nonoperative care with 4 weeks of immobilization, rehabilitation and no sport for 4 months (53 patients)
Follow-up
More than 2 years in the nonoperative group
Outcomes
Lesions seen at arthroscopy, judged by gross appearance without biopsy
Load‑shift translation graded by the Hawkins system
Recurrent instability in the nonoperative group
Key Findings
All 63 shoulders had a hemarthrosis, and 61 (97%) had a complete Perthes‑Bankart avulsion of the capsulolabral complex (Baker Type III) with no gross intracapsular injury.
Recurrent instability developed in 48 of the 53 patients (90%) who chose nonoperative treatment.
Every shoulder dislocated anteriorly on the load‑shift test under anesthesia (31 reduced on their own and 32 stayed out), although 62 of 63 showed no gross capsular injury.
Of the two shoulders without a Bankart lesion, one had a humeral avulsion of the glenohumeral ligament (HAGL) and the other had an interstitial capsular tear beside an intact labrum (Baker Type I).
Hill‑Sachs lesions were present in 57 shoulders (23 chondral, 34 osteochondral), none were large, and none appeared to affect stability at arthroscopy.
West Point views showed a glenoid rim fracture in 14 of 63 patients (22%), each confirmed at arthroscopy, and no shoulder had a rotator cuff tear.
Board pearl
In patients under 24 after a first‑time traumatic anterior dislocation, arthroscopy found a Perthes‑Bankart avulsion in 97%, and 90% of the separate group managed nonoperatively developed recurrent instability.
Authors' conclusion
In this population, the capsulolabral avulsion appeared to be the primary gross pathologic lesion after a first-time dislocation. These findings, associated with the 90% nonoperative recurrence rate, suggest a strong association between recurrent instability and the Perthes-Bankart lesion in this population.