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A Prospective, Randomized Evaluation of Arthroscopic Stabilization Versus Nonoperative Treatment in Patients with Acute, Traumatic, First-Time Shoulder Dislocations

Craig R. Bottoni, MD^,, John H. Wilckens, MD, Thomas M. DeBerardino, MD, Jean-Claude G. D’Alleyrand, MSE, Richard C. Rooney, MD, J. Kimo Harpstrite, MD and Robert A. Arciero, MD

Sports Medicine Section, Orthopaedic Surgery Service, Tripler Army Medical Center, Honolulu, Hawaii

Presented at the 26th annual meeting of the AOSSM, Sun Valley, Idaho, June 2000.

Address correspondence and reprint requests to LTC Craig R. Bottoni, MD, Sports Medicine, Orthopaedic Surgery Service, Tripler Army Medical Center, Honolulu, HI 96818-4920

Background: Nonoperative treatment of traumatic shoulder dislocations leads to a high rate of recurrent dislocations.

Hypothesis: Early arthroscopic treatment for shoulder dislocation will result in a lower recurrence rate than nonoperative treatment.

Study Design: Prospective, randomized clinical trial.

Methods: Two groups of patients were studied to compare nonoperative treatment with arthroscopic Bankart repair for acute, traumatic shoulder dislocations in young athletes. Fourteen nonoperatively treated patients underwent 4 weeks of immobilization followed by a supervised rehabilitation program. Ten operatively treated patients underwent arthroscopic Bankart repair with a bioabsorbable tack followed by the same rehabilitation protocol as the nonoperatively treated patients. The average follow-up was 36 months.

Results: Three patients were lost to follow-up. Twelve nonoperatively treated patients remained for follow-up. Nine of these (75%) developed recurrent instability. Six of the nine have required subsequent open Bankart repair for recurrent instability. Of the nine operatively treated patients available for follow-up, only one (11.1%) developed recurrent instability.

Conclusions: Arthroscopic stabilization of traumatic, first-time anterior shoulder dislocations is an effective and safe treatment that significantly reduces the recurrence rate of shoulder dislocations in young athletes when compared with conventional, nonoperative treatment.

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