Do I Need Surgery after a Shoulder Dislocation?

Primary Arthroscopic Stabilization for a First-Time Anterior Dislocation of the Shoulder: Long-Term Follow-up of a Randomized, Double-Blinded Trial (JBJS 2020)  

What was the purpose of this study?  

The aim of this study was to evaluate the long-term efficacy of arthroscopic Bankart repair (ABR). Basically, should we fix it or not? 

How did the authors study their question?  

•  88 patients with an age of ≤35 years who had sustained their 1st anterior glenohumeral dislocation were enrolled in a single-center, double-blinded clinical trial. 
•  Subjects were randomized to receive either an arthroscopic washout (AWO) *placebo* or ABR. Participants were reassessed after a minimum of 10 years postoperatively. 
•  Data regarding recurrent instability, revision surgery, satisfaction, and function (Disabilities of the Arm, Shoulder and Hand [DASH] and Western Ontario Shoulder Instability Index [WOSI]) scores were collected. 

What did the authors find? 

•  Sixty-five patients (74%; 32 in the AWO group and 33 in the ABR group) were included and had an average follow-up of 14.2 years (range,12 to 16 years). 
•  The rate of recurrent dislocation was significantly higher in the AWO group than the ABR group (47% and 12%, respectively; p = 0.002). Kaplan-Meier curves were plotted for event-free survival using recurrent instability and/or revision surgery as clinical end points. 
•  This analysis demonstrated a sustained significant difference between the groups at 10 years after surgery (58% for the AWO group versus 79% for the ABR group; log-rank test [Mantel-Cox]; p = 0.018). 
•  Long-term WOSI scores were significantly better in the ABR group. 
•  The presence of recurrent instability was associated with significantly poorer WOSI and DASH scores.  

How does this impact my clinical practice? 

This study demonstrates a long-term benefit in overall shoulder stability and functional outcome in high-risk patients who have undergone ABR for first-time anterior dislocation. In brief, there is utility in fixing the first time dislocator.

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Further Evidence: @AJSM.2021.Apr;49(5)

In patients with first-time shoulder dislocations, arthroscopic labral repair (Bankart procedure) reduced the risk of secondary shoulder dislocation and improved functional outcome versus nonoperative treatment after a 2-year follow-up.

The risk of recurrence after the first episode of anterior shoulder dislocation is high with nonoperative treatment in younger patients.