TY - JOUR
T1 - Surgical stabilization for first-time shoulder dislocators
T2 - a multicenter analysis
AU - MOON Shoulder Instability Group
AU - Rugg, Caitlin M.
AU - Hettrich, Carolyn M.
AU - Ortiz, Shannon
AU - Wolf, Brian R.
AU - Baumgarten, Keith M.
AU - Bishop, Julie Y.
AU - Bollier, Matthew J.
AU - Bravman, Jonathan T.
AU - Brophy, Robert
AU - Carpenter, James
AU - Cox, Charlie L.
AU - Feeley, Brian T.
AU - Grant, John A.
AU - Jones, Grant L.
AU - Kuhn, John E.
AU - Ma, C. Benjamin
AU - Marx, Robert G.
AU - McCarty, Eric
AU - Miller, Bruce S.
AU - Smith, Matthew V.
AU - Wright, Rick W.
AU - Zhang, Alan L.
N1 - Funding Information:
Eric McCarty consults for Zimmer Biomet. This author receives grant money from Smith & Nephew, Arthrex, and DePuy for fellowship support. This author receives money for a patent, unrelated to the submitted work. This author receives royalties from Elsevier.
Funding Information:
Rick W. Wright serves on the Board of Directors of the American Board of Orthopaedic Surgery and American Orthopaedic Association, which are not paid board positions. This author receives grant money from the National Institutes of Health and National Institute of Arthritis and Musculoskeletal and Skin Diseases, unrelated to the submitted work.
Funding Information:
An Orthopaedic Research Education Foundation grant provided financial assistance for this study (grant number 14-003).
Publisher Copyright:
© 2017 Journal of Shoulder and Elbow Surgery Board of Trustees
PY - 2018/4
Y1 - 2018/4
N2 - 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.
AB - 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.
KW - Glenohumeral instability
KW - biceps pathology
KW - first-time dislocator
KW - recurrent dislocator
KW - shoulder dislocation
KW - shoulder stabilization
UR - http://www.scopus.com/inward/record.url?scp=85041906078&partnerID=8YFLogxK
U2 - 10.1016/j.jse.2017.10.041
DO - 10.1016/j.jse.2017.10.041
M3 - Article
C2 - 29321108
AN - SCOPUS:85041906078
VL - 27
SP - 674
EP - 685
JO - Journal of Shoulder and Elbow Surgery
JF - Journal of Shoulder and Elbow Surgery
SN - 1058-2746
IS - 4
ER -