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International Orthopaedics

, Volume 43, Issue 12, pp 2799–2805 | Cite as

Early surgical treatment of first-time anterior glenohumeral dislocation in a young, active population is superior to conservative management at long-term follow-up

  • Angelo De CarliEmail author
  • Antonio Pasquale Vadalà
  • Riccardo Lanzetti
  • Domenico Lupariello
  • Edoardo Gaj
  • Guglielmo Ottaviani
  • Bhavik H. Patel
  • Yining Lu
  • Andrea Ferretti
Original Paper

Abstract

Purpose

To compare the long-term effectiveness of non-operative treatment with immediate arthroscopic surgical stabilization in young, active patients after first-time anterior glenohumeral dislocation.

Materials and methods

Consecutive patients aged 15–25 years who suffered primary traumatic anterior glenohumeral dislocation were enrolled in this prospective, non-randomized investigation. In total, 160 patients were enrolled—64 opted for surgical stabilization (group A), while 96 opted for conservative treatment (group B). At final follow-up of over 6.5 years, 60 patients in group A (96.7% males, age 22.8 ± 3.2) and 70 patients in group B (90.0% males, age 20.8 ± 2.9) were evaluated with physical examination, patient-reported outcome measures (PROMs), and radiological studies. Recurrence and return to sport (RTS) data were collected, and variables were compared between groups.

Results

Recurrence rate in group A was 13.3% at mean latency of 3.3 ± 1.9 years, compared to 71.4% at mean latency of 2.1 ± 1.5 years in group B (P < 0.001 for both recurrence rate and latency). In group A, 70.0% of patients RTS at the pre-injury level, versus 41.4% of patients in group B (P < 0.001). Patients in group A scored significantly higher on all PROMs (all P < 0.001) and had significantly less osteoarthritis (P = 0.004), when compared to group B.

Conclusion

Acute surgical stabilization of first-time anterior shoulder dislocation in young, active patients is more effective than conservative treatment at long-term follow up, based on lower recurrence rate, better RTS, and higher patient-perceived improvement.

Keywords

Anterior shoulder dislocation Shoulder instability Bankart repair Glenohumeral joint Conservative management 

Notes

Funding

Prof. Angelo De Carli is a consultant for Arthrex.

Prof. Andrea Ferretti is a consultant for Arthrex and Corin and received financial support from Depuy-Synthes, Groupe Lepine, Zimmer-Biomet, BBraun Aesculap, MBA.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  • Angelo De Carli
    • 1
    Email author
  • Antonio Pasquale Vadalà
    • 1
  • Riccardo Lanzetti
    • 1
  • Domenico Lupariello
    • 1
  • Edoardo Gaj
    • 1
  • Guglielmo Ottaviani
    • 1
  • Bhavik H. Patel
    • 2
  • Yining Lu
    • 2
  • Andrea Ferretti
    • 1
  1. 1.Orthopaedic unit and Kirk Kilgour Sports injury Center, S. Andrea HospitalUniversity of Rome “ Sapienza”RomeItaly
  2. 2.Midwest Orthopaedics at RushRush University Medical CenterChicagoUSA

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