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



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.


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.


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.


Anterior shoulder dislocation Shoulder instability Bankart repair Glenohumeral joint Conservative management 



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.


  1. 1.
    Brophy RH, Marx RG (2009) The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy 25(3):298–304CrossRefGoogle Scholar
  2. 2.
    Kirkley A, Werstine R, Ratjek A, Griffin S (2005) Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder: long-term evaluation. Arthroscopy 21(1):55–63CrossRefGoogle Scholar
  3. 3.
    Murray IR, Goudie EB, Petrigliano FA, Robinson CM (2013) Functional anatomy and biomechanics of shoulder stability in the athlete. Clin Sports Med 32(4):607–624CrossRefGoogle Scholar
  4. 4.
    Hovelius L, Olofsson A, Sandstrom B, Augustini BG, Krantz L, Fredin H, Tillander B, Skoglund U, Salomonsson B, Nowak J, Sennerby U (2008) Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. A prospective twenty-five-year follow-up. J Bone Joint Surg Am 90(5):945–952. CrossRefPubMedGoogle Scholar
  5. 5.
    Davy AR, Drew SJ (2002) Management of shoulder dislocation--are we doing enough to reduce the risk of recurrence? Injury 33(9):775–779CrossRefGoogle Scholar
  6. 6.
    te Slaa RL, Brand R, Marti RK (2003) A prospective arthroscopic study of acute first-time anterior shoulder dislocation in the young: a five-year follow-up study. J Shoulder Elb Surg 12(6):529–534. CrossRefGoogle Scholar
  7. 7.
    Wheeler JH, Ryan JB, Arciero RA, Molinari RN (1989) Arthroscopic versus nonoperative treatment of acute shoulder dislocations in young athletes. Arthroscopy 5(3):213–217CrossRefGoogle Scholar
  8. 8.
    Kane P, Bifano SM, Dodson CC, Freedman KB (2015) Approach to the treatment of primary anterior shoulder dislocation: a review. Phys Sportsmed 43(1):54–64. CrossRefPubMedGoogle Scholar
  9. 9.
    Olds M, Ellis R, Donaldson K, Parmar P, Kersten P (2015) Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. Br J Sports Med 49(14):913–922. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Longo UG, Loppini M, Rizzello G, Ciuffreda M, Maffulli N, Denaro V (2014) Management of primary acute anterior shoulder dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy 30(4):506–522CrossRefGoogle Scholar
  11. 11.
    Wasserstein DN, Sheth U, Colbenson K, Henry PD, Chahal J, Dwyer T, Kuhn JE (2016) The true recurrence rate and factors predicting recurrent instability after nonsurgical management of traumatic primary anterior shoulder dislocation: a systematic review. Arthroscopy 32(12):2616–2625CrossRefGoogle Scholar
  12. 12.
    Adam M, Attia AK, Alhammoud A, Aldahamsheh O, Al Ateeq Al Dosari M, Ahmed G (2018) Arthroscopic Bankart repair for the acute anterior shoulder dislocation: systematic review and meta-analysis. Int Orthop 42(10):2413–2422. CrossRefPubMedGoogle Scholar
  13. 13.
    Hovelius L, Rahme H (2016) Primary anterior dislocation of the shoulder: long-term prognosis at the age of 40 years or younger. Knee Surg Sports Traumatol Arthrosc 24(2):330–342CrossRefGoogle Scholar
  14. 14.
    Marshall T, Vega J, Siqueira M, Cagle R, Gelber JD, Saluan P (2017) Outcomes after arthroscopic Bankart repair: patients with first-time versus recurrent dislocations. Am J Sports Med 45(8):1776–1782. CrossRefPubMedGoogle Scholar
  15. 15.
    Rugg CM, Hettrich CM, Ortiz S, Wolf BR, Zhang AL (2018) Surgical stabilization for first-time shoulder dislocators: a multicenter analysis. J Shoulder Elb Surg 27(4):674–685. CrossRefGoogle Scholar
  16. 16.
    Plath JE, Saier T, Feucht MJ, Minzlaff P, Seppel G, Braun S, Hatch D, Imhoff AB (2018) Patients’ expectations of shoulder instability repair. Knee Surg Sports Traumatol Arthrosc 26(1):15–23CrossRefGoogle Scholar
  17. 17.
    Trojan JD, DeFroda SF, Mulcahey MK (2019) Patient understanding, expectations, outcomes, and satisfaction regarding surgical management of shoulder instability. Phys Sportsmed 47(1):6–9. CrossRefPubMedGoogle Scholar
  18. 18.
    Watson S, Allen B, Grant JA (2016) A clinical review of return-to-play considerations after anterior shoulder dislocation. Sports Health 8(4):336–341. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Owens BD, Dickens JF, Kilcoyne KG, Rue JP (2012) Management of mid-season traumatic anterior shoulder instability in athletes. J Am Acad Orthop Surg 20(8):518–526. CrossRefPubMedGoogle Scholar
  20. 20.
    Dickens JF, Rue JP, Cameron KL, Tokish JM, Peck KY, Allred CD, Svoboda SJ, Sullivan R, Kilcoyne KG, Owens BD (2017) Successful return to sport after arthroscopic shoulder stabilization versus nonoperative management in contact athletes with anterior shoulder instability: a prospective multicenter study. Am J Sports Med 45(11):2540–2546. CrossRefPubMedGoogle Scholar

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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