Caitlin M Rugg1, Carolyn M Hettrich2, Shannon Ortiz3, Brian R Wolf3, Alan L Zhang4. 1. Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA. 2. Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA. 3. Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA. 4. Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA. Electronic address: alan.zhang@ucsf.edu.
Abstract
BACKGROUND: Anterior shoulder dislocations in young patients are associated with high rates of recurrent instability. Although some surgeons advocate for surgical stabilization after a single dislocation event in this population, there is sparse research evaluating surgical treatment for first-time dislocators. METHODS: Patients undergoing surgical stabilization for anterior shoulder instability were prospectively enrolled at multiple institutions from 2015-2017 and stratified by number of dislocations before surgery. Demographic data, preoperative patient-reported outcomes, imaging findings, surgical findings, and procedures performed were compared between groups. Analysis of variance, χ2, and multivariate logistic regression were used for statistical analysis. RESULTS: The study included 172 patients (mean age, 25.3 years; 79.1% male patients) for analysis (58 patients with 1 dislocation, 69 with 2-5 dislocations, 45 with >5 dislocations). There were no intergroup differences in demographic characteristics, preoperative patient-reported outcomes, or physical examination findings. Preoperative imaging revealed increased glenoid bone loss in patients with multiple dislocation events (P = .043). Intraoperatively, recurrent dislocators were more likely to have bony Bankart lesions (odds ratio [OR], 3.26; P = .024) and biceps pathology (OR, 6.27; P = .013). First-time dislocators more frequently underwent arthroscopic Bankart repair and/or capsular plication (OR, 2.22; P = .016), while recurrent dislocators were more likely to undergo open Bristow-Latarjet procedures (OR, 2.80; P = .049) and surgical treatment for biceps pathology (OR, 5.03; P = .032). CONCLUSIONS: First-time shoulder dislocators who undergo stabilization are more likely to undergo an arthroscopic procedure and less likely to have bone loss or biceps pathology compared with recurrent dislocators. Future studies are needed to ascertain long-term outcomes of surgical stabilization based on preoperative dislocation events.
BACKGROUND: Anterior shoulder dislocations in young patients are associated with high rates of recurrent instability. Although some surgeons advocate for surgical stabilization after a single dislocation event in this population, there is sparse research evaluating surgical treatment for first-time dislocators. METHODS:Patients undergoing surgical stabilization for anterior shoulder instability were prospectively enrolled at multiple institutions from 2015-2017 and stratified by number of dislocations before surgery. Demographic data, preoperative patient-reported outcomes, imaging findings, surgical findings, and procedures performed were compared between groups. Analysis of variance, χ2, and multivariate logistic regression were used for statistical analysis. RESULTS: The study included 172 patients (mean age, 25.3 years; 79.1% male patients) for analysis (58 patients with 1 dislocation, 69 with 2-5 dislocations, 45 with >5 dislocations). There were no intergroup differences in demographic characteristics, preoperative patient-reported outcomes, or physical examination findings. Preoperative imaging revealed increased glenoid bone loss in patients with multiple dislocation events (P = .043). Intraoperatively, recurrent dislocators were more likely to have bony Bankart lesions (odds ratio [OR], 3.26; P = .024) and biceps pathology (OR, 6.27; P = .013). First-time dislocators more frequently underwent arthroscopic Bankart repair and/or capsular plication (OR, 2.22; P = .016), while recurrent dislocators were more likely to undergo open Bristow-Latarjet procedures (OR, 2.80; P = .049) and surgical treatment for biceps pathology (OR, 5.03; P = .032). CONCLUSIONS: First-time shoulder dislocators who undergo stabilization are more likely to undergo an arthroscopic procedure and less likely to have bone loss or biceps pathology compared with recurrent dislocators. Future studies are needed to ascertain long-term outcomes of surgical stabilization based on preoperative dislocation events.
Authors: Justin A Magnuson; Brian R Wolf; Kevin J Cronin; Cale A Jacobs; Shannon F Ortiz; John E Kuhn; Carolyn M Hettrich Journal: J Shoulder Elbow Surg Date: 2020-04 Impact factor: 3.019
Authors: Obiajulu Agha; Caitlin M Rugg; Drew A Lansdown; Shannon Ortiz; Carolyn M Hettrich; Brian R Wolf; Brian T Feeley Journal: Arthroscopy Date: 2020-06-12 Impact factor: 4.772
Authors: Rachel M Frank; Hytham S Salem; Catherine Richardson; Michael O'Brien; Jon M Newgren; Brian J Cole; Nikhil N Verma; Gregory P Nicholson; Anthony A Romeo Journal: Orthop J Sports Med Date: 2021-05-13
Authors: Courtney R Carlson Strother; Richard J McLaughlin; Aaron J Krych; Joaquin Sanchez-Sotelo; Christopher L Camp Journal: Arthrosc Tech Date: 2019-07-04
Authors: Peter N Chalmers; William Uffman; Garrett Christensen; Patrick Greis; Stephen Aoki; Richard Nelson; Minkyoung Yoo; Robert Z Tashjian Journal: JSES Int Date: 2020-03-16