Arthroscopic Repair versus Conservative Treatment for first-time Anterior Shoulder Dislocation

Abstract

To systematically compare the clinical efficacy of conservative treatment and arthroscopic one-stage repair for patients with first-time anterior dislocation of the shoulder. A retrieval and systematic review of randomized controlled studies of primary anterior shoulder dislocation with conservative versus arthroscopic repair was conducted and further pooled analysis was performed to compare the overall difference in clinical outcomes, including redislocation and revision surgery rates, shoulder function scores and related complications. Preliminary meta-analysis showed that the risk of anterior shoulder redislocation was 4.73-fold higher in patients treated conservatively than those undergoing arthroscopic repair (RR:4.73 [2.95–7.58], p < 0.000; I² = 0 %, p = 0.920),and that the revision surgery rate was 5.91 times higher in the conservative group than in the arthroscopic repair group (RR:5.91 [2.82–12.39], p < 0.000; I² = 0 %, p = 0.560).Early arthroscopic repair can significantly reduce the redislocation and revision surgery rates and also improve the shoulder joint function score, without serious complications. However, it is necessary to recognize the subset of patients with a higher risk of redislocation in young patients through a high quality, blinded, prospective cohort study when early arthroscopic repair intervention in this subset of high-risk patients will be of significant clinical value.

Zusammenfassung

Systematischer Vergleich der klinischen Wirksamkeit von konservativer Behandlung und arthroskopischer einzeitiger Reparatur bei Patienten mit erstmaliger vorderer Schulterluxation. Es wurde eine retrospektive Analyse von randomisierten kontrollierten Studien zur primären vorderen Schulterluxation mit konservativer versus arthroskopischer Reparatur durchgeführt und die Daten gepoolt, um Unterschiede bei den klinischen Ergebnissen zu vergleichen, einschließlich Redislokations- und Revisionsoperationsraten,

Schulterfunktionswerte und damit verbundene Komplikationen. Eine vorläufige Meta-Analyse zeigte, dass das Risiko einer vorderen Schulter der vorderen Schulter bei konservativ behandelten Patienten 4,73-mal höher war als bei Patienten, die arthroskopisch behandelt wurden (RR:4,73 [2,95–7,58], p < 0,000; I² = 0 %, p = 0,920), und dass die Revisionsoperationsrate in der konservativ behandelten Gruppe 5,91-mal höher war als in der arthroskopischen behandelten Gruppe (RR:5,91 [2,82–12,39], p < 0,000; I² = 0 %, p = 0,560). Eine frühzeitige arthroskopische Reparatur reduziert signifikant die Redislokations- und Revisionsoperationsrate und kann auch den Funktionsscore des Schultergelenks verbessern, ohne ernsthafte Komplikationen. Es ist jedoch notwendig, die Untergruppe der Patienten mit einem höheren Risiko einer Redislokation bei jungen Patienten durch eine qualitativ hochwertige, verblindete, prospektive Kohortenstudie zu identifizieren, wenn eine frühzeitige arthroskopische Intervention bei dieser Subgruppe von Hochrisikopatienten von signifikantem klinischen Wert sein soll.

Keywords

first-time anterior shoulder dislocation - arthroscopy - conservative treatment

Schlüsselwörter

Erstmalige anteriore Schulterluxation - Arthroskopie - konservative Behandlung

• References

• 1 Krøner K, Lind T, Jensen J. The epidemiology of shoulder dislocations. Arch Orthop Trauma Surg 1989; 108: 288-290
• 2 Kao J T, Chang CL, Su W R. et al. Incidence of recurrence after shoulder dislocation: a nationwide database study. J Shoulder Elbow Surg 2018; 27: 1519-1525
• 3 Olds M, Ellis R, Parmar P. et al. The immediate and subsequent impact of a first-time traumatic anterior shoulder dislocation in people aged 16–40: Results from a national cohort study. Shoulder Elbow 2021; 13: 223-232
• 4 Olds M, Ellis R, Donaldson K. et al. 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 2015; 49: 913-922
• 5 De Carli A, Vadalà AP, Lanzetti R. et al. Early surgical treatment of first-time anterior glenohumeral dislocation in a young, active population is superior to conservative management at long-term follow-up. Int Orthop 2019; 43: 2799-2805
• 6 Dickens JF, Rue JP, Cameron K L. et al. 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 2017; 45: 2540-2546
• 7 Longo U G, van der Linde J A, Loppini M. et al. Surgical versus nonoperative treatment in patients up to 18 years oldwith traumatic shoulder instability: a systematic review and quantitative synthesis of the literature. Arthroscopy 2016; 32: 944-952
• 8 Hurley ET, Manjunath AK, Bloom DA. et al. Arthroscopic bankart repair versus conservative management for first-time traumatic anterior shoulder instability: a systematic review and meta-analysis. Arthroscopy 2020; 36: 2526-2532
• 9 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097
• 10 Higgins JPT, Altman DG, Gøtzsche PC. et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
• 11 Kirkley A, Griffin S, Richards C. et al. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder. Arthroscopy 1999; 15: 507-514
• 12 Kirkley A, Werstine R, Ratjek A. et al. 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 2005; 21: 55-63
• 13 Bottoni CR, Wilckens JH, DeBerardino TM. et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med 2002; 30: 576-580
• 14 Jakobsen BW, Johannsen HV, Suder P. et al. Primary repair versus conservative treatment of first-time traumatic anterior dislocation of the shoulder: a randomized study with 10-year follow-up. Arthroscopy 2007; 23: 118-123
• 15 Robinson CM, Jenkins PJ, White TO. et al. Primary arthroscopic stabilization for a first-time anterior dislocation of the shoulder. A randomized, double-blind trial. J Bone Joint Surg Am 2008; 90: 708-721
• 16 Yapp LZ, Nicholson JA, Robinson CM. Primary arthroscopic stabilization for a first-time anterior dislocation of the shoulder: long-term follow-up of a randomized, double-blinded trial. J Bone Joint Surg Am 2020; 102: 460-467
• 17 Pougès C, Hardy A, Vervoort T. et al. Arthroscopic bankart repair versus immobilization for first episode of anterior shoulder dislocation before the age of 25: a randomized controlled trial. Am J Sports Med 2021; 49: 1166-1174
• 18 te Slaa RL, Brand R, Marti RK. A prospective arthroscopic study of acute first-time anterior shoulder dislocation in the young: a five-year follow-up study. J Shoulder Elbow Surg 2003; 12: 529-534
• 19 Hovelius L, Olofsson A, Sandstrom B. et al. Nonoperative treatment of primary anterior shoulder in patients forty years of age and risk of recurrence A prospective Twenty-five-year follow-up. J Bone Joint Surg Am 2008; 90: 945-952
• 20 Heidari K, Asadollahi S, Vafaee R. et al. Immobilization in external rotation combined with abduction reduces the risk of recurrence after primary anterior shoulder dislocation. J Shoulder Elbow Surg 2014; 23: 759-766
• 21 Whelan DB, Kletke SN, Schemitsch G. et al. Immobilization in external rotation versus internal rotation after primary anterior shoulder dislocation: a meta-analysis of randomized controlled trials. Am J Sports Med 2016; 44: 521-532
• 22 Minkus M, Konigshausen M, Pauly S. et al. Immobilization in external rotation and abduction versus arthroscopic stabilization after first-time anterior shoulder dislocation: a multicenter randomized controlled trial. Am J Sports Med 2021; 49: 857-865
• 23 Kao JT, Chang CL, Su WR. et al. Incidence of recurrence after shoulder dislocation: a nationwide database study. J Shoulder Elbow Surg 2018; 27: 1519-1525
• 24 Olds M, Donaldson K, Ellis R. et al. In children 18 years and under, what promotes recurrent shoulder instability after traumatic anterior shoulder dislocation? A systematic review and meta-analysis of risk factors. Br J Sports Med 2016; 50: 1135-1141