The recurrence rate after primary shoulder dislocation in young subjects with high functional demand is close to 75%. The present study assessed the interest of emergency arthroscopic stabilization in this specific population.
Material and methods
A non-randomized prospective study included 31 athletes under 30years of age with primary anterior shoulder dislocation. Fifteen were offered emergency stabilization; after informed consent, 14 were enrolled in the “emergency stabilization” group. This was compared to a group matched for age, sport and lesion, managed 1year previously by “non-operative” treatment (n=17), divided into 2 subgroups: “immobilization” and “secondary stabilization”. Continuous prospective assessment of recurrence, return to sport and function (QuickDASH, QDsport, Duplay and Rowe scores) enabled comparison between the 3 groups.
Mean follow-up was 19months for the “emergency stabilization” group and 25months for the “non-operative” group. There were no failures in the “emergency stabilization” group, compared to a 77% rate in the “non-operative” group with onset at a mean 7.5months and a mean 2.6episodes of recurrence. Seven (54%) of the failures of non-operative treatment required secondary stabilization. Ninety-three percent of the “emergency stabilization” group, 44% of the “immobilization” group and 71% of the “secondary stabilization” group resumed sport at least at their pre-dislocation level. Mean Quick DASH was 1.46 in the “emergency stabilization” group, versus 15.28 the “immobilization” group (P<0.05) and 16.96 in the “secondary stabilization” group. Mean Duplay and Rowe scores were respectively 92.9 and 95 in the “emergency stabilization” group, versus 59.44 and 61.1 in the “immobilization” group (P<0.05) and 85 and 93.57 in the “secondary stabilization” group.
Emergency arthroscopic stabilization limits recurrence (Kirkley et al.), with better functional results than for secondary stabilization, lesion “freshness” providing a more favorable environment for labral and ligamentary healing. These encouraging results need confirmation over longer follow-up.Le texte complet de cet article est disponible en PDF.
Keywords : Shoulder dislocation, Athlete, Bankart, Arthroscopic stabilization, Emergency