Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2021;9(10):21 Am J Sports Med. 2021 Mar;49(4): 857-865What this means for my practice?
Results of this trial suggest that treatment of first-time shoulder dislocations through arthroscopic primary stabilization provides significantly lower recurrence rate at 1-year post-treatment, but provide shoulder functionality, compared to immobilization in external rotation and abduction. This randomized controlled trial was limited by the small total sample size (n=112), significant loss to follow-up in the immobilization group, and a lack of recording of complications or adverse events. Therefore, future randomized controlled trials with larger sample size including adverse event data are needed to confirm the findings of this trial.
Study Summary
One hundred and twelve patients who suffered from a 1st time dislocation of the shoulder were randomized to receive immobilization in external rotation and abduction (n=60) or surgery through an arthroscopic Bankart repair (n=52). The primary outcome of interest included rate of recurrence. Secondary outcomes included range of motion (ROM) and shoulder function (Constant-Murley score, subjective clinical shoulder scores, Rowe score, and the Western Ontario Shoulder Instability Index [WOSI]). Results revealed that the rate of recurrence was significantly lower in the surgical group compared to the immobilization group (p=0.016). Specifically, 9 cases of atraumatic and traumatic instability were observed in the immobilization group (n=9); 1 event of traumatic subluxation was observed in the surgery group. All secondary outcomes were not significantly different between the 2 groups (p>0.05 for all) at any of the timepoints.
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