Recurrence rates and factors affecting recurrence after traumatic anterior shoulder dislocation

Year 2021, Volume: 3 Issue: 2, 140 - 144, 24.04.2021

Mehmet Ozbey Buyukkuscu , Ahmet Kulduk Abdurrahman Aydın Engin Çetinkaya , Şükrü Sarper Gürsü

https://doi.org/10.38053/acmj.881784

Abstract

Objective: To investigate the factors affecting the recurrence of anterior shoulder dislocation, identify the patient group with the highest recurrence rate for shoulder dislocation, and determine the patient population to be recommended surgical treatment after primary dislocation.
Material and Methods: Patients diagnosed with primary shoulder dislocation and treated in our hospital between January 2005 and January 2017 were retrospectively screened. Of the 1395 patients identified, 1253 were reached by phone to obtain follow-up information. Patients whose follow-up information was not available, those with posterior dislocations, multidirectional instabilities, general joint hypermobility, traumatic nerve injury or shoulder fracture-dislocations (including greater tuberosity and glenoid fractures), and those that had undergone surgical treatment after primary dislocation were excluded from the study. The general joint laxity of the patients was evaluated using the Beighton scale. Patients with traumatic primary anterior shoulder dislocation and at least two years of follow-up data were included in the study and divided into three age groups as under 20, 20 to 40, over 40.
Results: After applying the exclusion and inclusion criteria, 1,004 patients were included in the study. Recurrence was detected in 408 of these patients (40.6%). The highest recurrence rate was in the under 20 years old group at 52% (88/170). The recurrence rate was determined as 43% (283/659) for the 20-40 years group and 21% (37/175) for the over 40 group. It was determined that except for age, gender and presence of bone defects (Hill-Sachs lesion), the remaining parameters, namely immobilization time, injury mechanism, presence and type of sports activity, dominant-side dislocation, and smoking had no significant effect on the risk of recurrence after primary dislocation.
Conclusion: In conclusion, the surgical treatment option should be presented to young male patients with bone defects after primary dislocation and they should be informed about the possible problems due to recurrent instability.

Keywords

Shoulder Dislocation, First, Recurrence, Risk Factors, Surgical treatment

Supporting Institution

yok

Project Number

-

Thanks

-

References

• Wasserstein DN, Sheth U, Colbenson K, et.al. The true recurrence rate and factors predicting recurrent instability after nonsurgical management of traumatic primary anterior shoulder dislocation: a systematic review. Arthroscopy 2016; 32: 2616-25.
• Boffano M, Mortera S, Piana R. Management of the first episode of traumatic shoulder dislocation. EFORT Open Rev 2017; 13: 35-40.
• Kane P, Bifano SM, Dodson CC, Freedman KB. Approach to the treatment of primary anterior shoulder dislocation: A review. Phys Sportsmed 2015; 43: 54-64.
• Khiami F, Gérometta A, Loriaut P. Management of recent first-time anterior shoulder dislocations. Orthop Traumatol Surg Res 2015; 101: 51-7.
• Robinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am 2006; 88: 2326-36.
• Kralinger FS, Golser K, Wischatta R, Wambacher M, Sperner G. Predicting recurrence after primary anterior shoulder dislocation. Am J Sports Med 2002; 30: 116-20.
• Pehlivan O. Open surgical stabilization of anterior glenohumeral instability: Indications and early term results. Eklem Hastalik Cerrahisi 2002; 13: 136-40.
• Sofu H, Gürsu S, Koçkara N, Oner A, Issın A, Camurcu Y. Recurrent anterior shoulder instability: Review of the literature and current concepts. World J Clin Cases 2014; 16: 676-82.
• teSlaa RL, Wijffels MP, Brand R, Marti RK. The prognosis following acute primary glenohumeral dislocation. J Bone Joint Surg Br 2004; 86: 58-64.
• Kavaja L, Lähdeoja T, Malmivaara A, Paavola M. Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis. Br J Sports Med 2018; 52: 1498-506.
• Shields DW, Jefferies JG, Brooksbank AJ, Millar N, Jenkins PJ. Epidemiology of glenohumeral dislocation and subsequent instability in an urban population. J Shoulder Elbow Surg 2018; 27: 189-95.
• Olds MK, Ellis R, Parmar P, Kersten P. Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation. BMJ Open Sport Exerc Med 2019; 7: 5.
• Juul-Kristensen B, Rogind H, Jensen DV, Remvig L. Interexaminer reproducibility of tests and criteria for generalized joint hypermobility and benign joint hypermobility syndrome. Rheumatology (Oxford) 2007; 46: 1835–41.
• Marshall T, Vega J, Siqueira M, Cagle R, Gelber JD, Saluan P. Outcomes after arthroscopic bankart repair: patients with first-time versus recurrent dislocations. Am J Sports Med 2017; 45: 1776-82.
• van Kampen DA, van den Berg T, van der Woude HJ, Castelein RM, Terwee CB, Willems WJ. Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability. J Shoulder Elbow Surg 2013; 22: 1310-9. 
• Vermeiren J, Handelberg F, Casteleyn PP, Opdecam P. The rate of recurrence of traumatic anterior dislocation of the shoulder: a study of 154 cases and a review of the literature. Int Orthop 1993; 17: 337-41.
• Jakobsen BW, Johannsen HV, Suder P, Søjbjerg JO. Primary repair versus conser-vative treatment of first-time traumatic anterior dislocation of the shoulder: a randomized study with 10-year follow-up. Arthrosc J Arthrosc Relat Surg 2007; 23: 118–23.
• Scheibel M, Kuke A, Nikulka C, Magosch P, Ziesler O, Schroeder RJ. How longshould acute anterior dislocations of the shoulder be immobilized in externalrotation? Am J Sports Med 2009; 37: 1309–16.
• Smith TO. Immobilisation following traumatic anterior glenohumeral joint dis-location: a literature review. Injury 2006; 37: 228–37.
• Lill H, Korner J, Hepp P, Verheyden P, Josten C. Age-dependent prognosis following conservative treatment of traumatic anterior shoulder dislocation. Eur J Trauma 2001; 27: 29–33.
• Hovelius L, Olofsson A, Sandström B, et al. Non-operative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. a prospective twenty-five-year follow-up. J Bone Joint Surg Am 2008; 90: 945-52.
• Leroux T, Wasserstein D, Veillette C, et al. Epidemiology of primary anterior shoulder dislocation requiring closed reduction in Ontario, Canada. Am J Sports Med 2014; 42: 442-450.
• Hovelius L, Rahme H. Primary anterior dislocation of the shoulder: long‑term prognosis at the age of 40 years or younger. Knee Surg Sports Traumatol Arthrosc 2016; 24: 330-42
• Simonet WT, Cofield RH. Prognosis in anterior shoulder dislocation. Am J Sports Med 1984; 12: 19-24.
• Bishop JA, Crall TS, Kocher MS. Operative versus non-operative treatment after primary traumatic anterior glenohumeral dislocation: expected-value decision analysis. J Shoulder Elbow Surg 2011; 20: 1087–94.
• Polyzois I, Dattani R, Gupta R, Levy O, Narvani AA. Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment. Arch Bone Jt Surg 2016; 4: 104-8. 
• Hovelius L, BG Augustini, H Fredin, O Johansson, R Norlin, J Thorling. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 1996; 78: 1677-84.
• Sachs RA, Lin D, Stone ML, Paxton E, Kuney M. Can the need for future surgery for acute traumatic anterior shoulder dislocation be predicted? J Bone Joint Surg Am 2007; 89: 1665-74.
• Olds M, Ellis R, Donaldson K, Parmar P, Kersten P. 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: 913-22. 
• Henry JH, Genung JA. Natural history of glenohumeral dislocationd revisited. Am J Sports Med 1982; 10: 135-7.
• Safran O, Milgrom C, Radeva-Petrova DR, Jaber S, Finestone A. Accuracy of the anterior apprehension test as a predictor of risk for redislocation after a first traumatic shoulder dislocation. Am J Sports Med 2010; 38: 972-5.
• Salomonsson B, von Heine A, Dahlborn M, et al. Bony Bankart is a positive predictive factor after primary shoulder dislocation. Knee Surg Sports Traumatol Arthrosc 2010; 18: 1425-31. 
• Hoelen MA, Burgers AMJ, Rozing PM. Prognosis of primary anterior shoulder dislocation in young adults. Arch Orthop Trauma Surg 1990; 110: 51–4.
• Hovelius L, Lind B, Thorling J. Primary dislocation of the shoulder: factors affecting the two year prognosis. Clin Orthop 1983; 176: 181-5.
• Hovelius L. Anterior dislocation of the shoulder in teenagers and young adults: five-year prognosis. J Bone Joint Surg [Am] 1987; 69-A: 393-9.