Abstract
Aims: The re-dislocation rates in adults (< 30 years) in the initial 12 months after FAT (first,anterior,traumatic) shoulder dislocations treated non-operatively vary from 25% to 95%. Some surgeons advocate early arthroscopic surgery following such dislocations as this appears to reduce recurrent instability. The purpose of this study was to establish if arthroscopic surgery reduces the incidence of recurrent instability after such dislocations when compared to non-operative treatment.
Material and Methods: Specific search terms were used to retrieve relevant studies from MEDLINE, EMBASE, and CINAHL extending from 1966 to October 2003. Guidelines for reporting of meta-analysis, adapted from QUOROM statement were followed. Adults under 30 years of age, with clinical and radiological confirmation of anterior dislocation following trauma with a minimum follow-up of 12 months were included. Patients with previous shoulder problems, generalised joint laxity, neurological injury, impingement and a history of substance abuse were excluded.
Results: 13 studies involving 433 shoulders were reviewed.
Group A included 84 shoulders treated by arthroscopic lavage without stabilisation. There were no subluxations. The re-dislocation rate was 14.3% (12/84).
Group B had 179 shoulders treated by arthroscopic stabilisation. The incidence of subluxation was 5.02% (9/179) and dislocation was 6.14% (11/179).
Recurrent instability (subluxation /dislocation) following arthroscopic lavage (12/84 – 14.3%) was significantly higher than after arthroscopic stabilisation (20/179 – 11.2%). [p= 0.04, Relative risk = 2.32, 95% CI: 1.07 to 5.05]
Group C involved 170 shoulders treated non-operatively. The incidence of subluxation was 8% (12/150) and dislocation was 62% (93/150). The overall incidence of recurrent instability was 70% (119/170).
Recurrent instability following arthroscopic intervention (32/263 – 12.2%) was significantly lower than following non-operative treatment (119/170 – 70%) [p< 0.0001, Relative risk = 0.17, 95% CI: 0.12 to 0.24].
Conclusion: Early arthroscopic surgery reduces recurrent instability during the initial 12 months after FAT shoulder dislocation in young adults (< 30 years) when compared to non-operative treatment. Arthroscopic treatment should be offered to young, athletic patients especially those involved in contact sports or defence personnel, who are at a high risk of recurrent instability after initial shoulder dislocation. Further randomised control trials reporting on a larger number of patients with a minimum follow-up of 5 years are required before one can draw firm conclusions on the ability of arthroscopic intervention to influence the natural history of FAT shoulder dislocation.
Honorary Secretary Mr Bimal Singh. Correspondence should be addressed to BOSA (British Orthopaedic Specialists Association), c/o Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, London WC2A 3PE.
