PREDISPOSING FACTORS FOR RECURRENT SHOULDER DISLOCATION AFTER ARTHROSCOPIC TREATMENT

Authors: G Porcellini; F Campi; F Pegreffi; P Paladini;

References: Presented at SECEC 2009

Purpose
Accidental traumatic episodes involving forced abduction and external rotation of the shoulder can cause anterior subluxation or dislocation resulting in anterior instability. Despite major advances, arthroscopic stabilization techniques are still associated with higher failure rates than traditional open procedures, especially in young adults. We hypothesized that patients at higher risk of redislocation could be recognized preoperatively based on clinical history The aim of this study was to identify the risk factors for recurrence in a community-based population with traumatic unidirectional instability treated by a single arthroscopic technique.

Material and Methods
A total of 625 shoulder procedures for instability were performed by a single surgeon from January 2000 to December 2003, 385 matched the inclusion criteria. Glenoid labrum lesions were treated with three mini screws placed on the anterior-inferior rim of the glenoid from three to five o'clock. The sutures were passed through the inferior glenohumeral ligament, under the detached glenoid labrum, using a sliding knot to fix and retension the capsular-labral complex firmly to the glenoid. Clinical follow-up was at 3, 6, 12, 24 and 36 months. X-rays were taken at 12 and 36 months. Data were subjected to multiple logistic regression analysis.

Results
At 36 months, 31 (8.1%) patients had experienced redislocation ; the rate was 13.3% among patients < = 22 years old and 6.3% in older patients. Age at the first dislocation, male gender and time from first dislocation to surgery were significant risk factors for recurrence (p<0.05), whereas the number of previous dislocations and lesion type did not affect outcomes significantly.

Conclusion
Our data demonstrate that patients who are more likely to experience a redislocation can be identified preoperatively based on gender, age, and time from first dislocation to surgery.