Fewer re-injuries found with operative treatment for first-time shoulder dislocations

Authors: Gina Brockenbrough

References: ORTHOPAEDICS TODAY INTERNATIONAL 2005; 8:35. May 2005

Abstract
The treatment of first-time traumatic shoulder dislocation places surgeons in a difficult position: Either operate and risk tissue damage or immobilize patients and increase the chance of recurrent injury. But a new study on patients with dislocations and anterior lesions promotes the use of open repair.

At a 10-year follow up researchers found that 62% of patients treated conservatively sustained recurrent injuries vs. 9% who underwent operation. “So in conclusion to our results, the re-occurrence rate of nonoperative treatment of traumatic shoulder dislocation is high. Primary repair reduces this recurrence rate significantly,” said Bent W. Jakobsen, MD, an orthopaedist with the Åarhus University Hospital, Denmark.

Investigators also discovered that 80% of conservatively treated patients who re-dislocated their shoulders went on to have an operation. After the procedure, 69% of these patients reported good or excellent results, Jakobsen said during his presentation at the 2005 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress.

Multicenter study “At two years, 3% of the repair group had recurrence versus 53% in the conservative group.” — Bent W. Jakobsen

The multicenter study examined 76 patients with first-time traumatic shoulder dislocation. Researchers included participants aged 15 to 39 years diagnosed with anterior Bankart lesions. Nearly half of participants sustained full-contact sport injuries, Jakobsen said. The study primarily consisted of men (62 patients), researchers said in their abstract.

Investigators verified lesions through arthroscopy. In their abstract, researchers said that they found the rates for Bankart type 1, 2 and 3 lesions of 6.6%, 13.2% and 80.3%, respectively. They randomized patients into surgical and nonoperative groups. Surgeons performed open procedures, which included dividing the scapula and using Bankart repair techniques, Jakobsen said. Patients in both groups had similar rehabilitation protocol.

Researchers conducted a two-year follow-up and also questioned patients by phone 10 years after treatment. Most patients (97%) participated in the 10-year follow-up. Only two patients did not complete self-assessments, he said. Researchers also reviewed hospital records and examined patients with problems.

Investigators discovered higher re-dislocation rates for immobilization at the short-term follow up. “At two years, 3% of the repair group had recurrence versus 53% in the conservative group,” Jakobsen said. In a comparison of patients without subsequent dislocation, the conservative treatment group also showed more positive results on apprehension tests (39% vs. 7%), researchers said in their abstract.

They found similar dislocation results at 10 years. The operative group showed a 9% re-injury rate vs. 62% of the nonsurgical group, Jakobsen said. Repair patients that sustained second dislocations incurred re-injury during the first, second and fifth years postoperation, he said. “And all of them were young patients,” Jakobsen said.

Researchers discovered that more surgical patients were satisfied with their treatment. “Seventy-two percent of the primary repair group had a good or excellent result,” he said. But some reported symptoms after operation. Researchers found that 11% had pain and stiffness, while 6% suspected joint instability, Jakobsen said. Conversely, 75% of immobilized patients reported that they were unsatisfied with their outcomes. They also reported pain (10%) and suspected instability (3%), he said.

The findings may provide surgeons with better patient selection guidelines. “And we do suggest active [treatment] in younger patients maybe below 30 years of age, as this is currently indicated for, or wait for the next dislocation or problem cases with older patients,” Jakobsen said.

For more information: Jakobsen BW, Suder P. Primary repair versus conservative treatment after first time traumatic anterior shoulder dislocation. #21. Presented at the 2005 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress. April 3-7, 2005. Hollywood, Florida, U.S.A.