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

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Purpose: To report the long-term results of a prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation after a first traumatic anterior dislocation of the shoulder. Type of Study: Randomized clinical trial. Methods: Forty subjects younger than 30 years with a first traumatic anterior shoulder dislocation were randomized to receive immediate anterior stabilization plus rehabilitation or immobilization followed by rehabilitation. Patients completed the American Shoulder and Elbow Surgeons (ASES), Disabilities of the Arm, Shoulder and Hand (DASH), and the Western Ontario Shoulder Instability Index (WOSI) questionnaires. Results: At an average follow-up of 75 months, there was a significant difference in the rate of redislocation between the groups but no statistical significant difference in shoulder function with the ASES or the DASH. The mean difference between the 2 groups with the WOSI estimates a small, but clinically significant difference. Conclusions: It is recommended that immediate arthroscopic stabilization is the treatment of choice in a subset of patients who are younger than 30 years and are higher level athletes, and the timing for surgery is good or their sport is risky, i.e., rugby, football, kayaking, rock climbing. Level of Evidence: Level II.

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Methods

In 1999, Kirkley et al.14 reported the results of a randomized clinical trial in which 40 patients younger than 30 years received either immediate arthroscopic stabilization or immobilization for 3 weeks followed by identical rehabilitation.14 The study was designed as a prospective, 2-center, randomized clinical trial. It was single-blinded in that a research assistant, who was unaware of the treatment group the patient had been assigned to, performed all evaluations. To achieve this blinding,

Results

Thirty-three of the 40 original subjects were found and contacted by telephone; 31 agreed to be evaluated and returned questionnaire data, 16 from the surgical treatment group and 15 from the traditional treatment group. The average follow-up time was 79 months (range, 51 to 102 months). The groups remain similar with respect to age at first dislocation, gender mix, hand dominance, and whether or not the original dislocation occurred during sports activities (Table 1).

Since the study results

Discussion

In the knee, evidence is slowly mounting that early stabilization after a tear of the anterior cruciate ligament is in the young active patient’s best interest. It is believed that preventing the impact of loading on articular cartilage and subchondral bone that occurs during a pivoting episode and minimizing the shear loading on menisci and articular cartilage that occurs with daily activities may prevent osteoarthritis in the anterior cruciate ligament–deficient knee. Therefore, most

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    Dr. Kirkley died September 8, 2002

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