Published 9/1/2010
Peter Pollack

Shoulder dislocation in the young patient

Arthroscopic treatment may be better treatment for first-time dislocations

Arthroscopic treatment of traumatic anterior-inferior shoulder dislocation offers greater patient satisfaction than conservative treatment in younger patients, according to data presented by Rico Listringhaus, MD, at the annual meeting of the Arthroscopy Association of North America. Dr. Listringhaus and his coauthors are associated with the Center for Orthopedics and Traumatology, St Anna Hospital, in Herne, Germany.

“We conducted this study to prospectively compare treatment outcomes for first-time traumatic anterior-inferior shoulder dislocation in adolescent patients,” explained Dr. Listringhaus.

Satisfaction and redislocation
The research team evaluated 33 patients aged 15 to 18 years who had a first-time traumatic anterior-inferior dislocation and were candidates for arthroscopic stabilization. All patients in both groups were confirmed via magnetic resonance imaging to have Bankart lesions.

In consultation with their parents, 18 of the 33 patients agreed to surgical treatment. Surgical treatment consisted of arthroscopic stabilization of the capsule-labrum complex, using absorbable suture anchors. The 15 patients who chose not to have surgery were treated with slings during the initial posttraumatic phase.

The authors used the Rowe Score for Instability to evaluate 30 of the patients at 12, 24, and 36 months follow-up. If a patient had any dislocation of the treated shoulder during the course of follow-up, the research team counted the treatment as having failed.

Overall, 16 patients in the surgical group and 14 patients in the nonsurgical group were available for the full term of follow-up. Three patients in the surgical group and 10 patients in the nonsurgical group experienced a second dislocation during the follow-up period. Both groups had similar increases in mean Rowe scores for instability at each follow-up point (Table 1).

In addition, 16 of the 18 patients in the surgical group rated their result as “good” or “excellent,” compared to only 5 of the 15 in the nonsurgical group.

“We found a lower rate of recurrence and higher patient satisfaction among patients in the arthroscopic surgery group,” said Dr. Listringhaus. “We believe that the crucial factor might be the anatomic reconstruction of the damaged anterior-inferior capsule-labrum complex.”

Dr. Listringhaus’ coauthors for “Conservative or Arthroscopic Treatment of First Time Traumatic Anterior-Inferior Shoulder Dislocation in Adolescents—Prospective Results after 36 Months” were Roderich Heikenfeld, MD, and Georgios Godolias, MD.

Disclosure information: The authors report no conflicts.

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaos.org

Bottom line

  • This prospective study conducted in Germany examined outcomes for arthroscopic surgical versus nonsurgical treatment of first-time traumatic anterior-inferior shoulder dislocation.
  • Even through Rowe scores were similar, patients treated arthroscopically for a first-time shoulder dislocation had a lower rate of subsequent dislocation and were more satisfied than patients treated nonsurgically.