Acute Surgical Stabilization for First-Time Shoulder DislocationThe military is a good place to study injuries in young athletes. The need to return soldiers to their line of duty sometimes means they are treated more aggressively than is common in the civilian population. In this study, a group of 48 soldiers were treated surgically for a first-time anterior (forward) shoulder dislocation. The long-term results of this approach are investigated.
First-time shoulder dislocations are often treated conservatively without surgery. A rehab program of exercises to strengthen and stabilize the shoulder is recommended. Soldiers (and athletes) get back into action after several weeks to months. But there's always the risk of another shoulder dislocation. Recurrent dislocations occur most often with extreme activity such as volleyball, football, water skiing, and military training.
First-time dislocations with severe damage to the shoulder are more likely to be repaired surgically. This is often the case when there has been a capsulolabral avulsion. This type of injury refers to the fact that the labrum has pulled away from the bone. The labrum is a dense ring of fibrous cartilage around the shoulder socket. It gives the shoulder socket some depth and provides the shoulder with increased stability.
If the labral tear extends up far enough, it will even pull some of the biceps tendon away from where it inserts into the labrum. The surgical procedure used most often to treat this type of injury is called the Bankart repair. During the procedure, the surgeon repairs each of the soft tissues damaged by the dislocation. Suture anchors are used to hold the biceps in place.
Studies show that early results of surgical stabilization are excellent. This study attempted to report on the long-term results. They followed their patients for at least nine years (some as long as 14 years). They used patient questionnaires to ask about shoulder/arm function, pain levels, and patient satisfaction with the results.
Because this was mostly a military group, return to athletic activity and physical conditioning (such as doing push-ups) were also monitored. Only one person left the military for medical reasons and that was not for a shoulder problem. About 40 per cent of the group had recurring instability (partial or complete dislocation). A small number of these patients went on to have a second (revision) surgery to stabilize the shoulder.
Good shoulder function was reported for all patients in the study -- even those who had recurrent dislocations. Good shoulder function means they returned to unrestricted physical activity required by their jobs and daily activities. That was important as this group of patients had a vested interest in returning to active duty status or returning to military academy in order to graduate.
The authors acknowledge this treatment of surgical stabilization for first-time acute anterior shoulder dislocation is considered too aggressive by some experts. But they defend this practice because their studies and records show very poor results for soldiers with conservative care for this injury. They make note of the fact that this population is unique in that they cannot modify their activities.
This more aggressive approach made it possible for military patients to resume full activities and complete their military obligation. Long-term follow-up revealed the patients were satisfied with the results. Most of them said they would do it over again the same way if given the choice.
The authors also note that the system used in a Bankart repair for these patients treated in the mid-1990s was a tack system (Suretac device), which has since been replaced by the suture anchors used today. It's unknown how the long-term results compare between the tack system and suture anchors.
MAJ Brett D. Owens, MD, et al. Long-Term Follow-up of Acute Arthroscopic Bankart Repair for Initial Anterior Shoulder Dislocations in Young Athletes. In American Journal of Sports Medicine. April 2009. Vol. 37. No. 4. Pp. 669-673.
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