This is especially for my orthopedic colleagues. I came across this very good article “Primary arthroscopic stabilization for a first-time anterior dislocation of the shoulder. A Randomized, double- blind trial.” J Bone Joint Surg Am. 2008;90:708-721
<!– /* Font Definitions */ @font-face {font-family:SimSun; panose-1:2 1 6 0 3 1 1 1 1 1; mso-font-alt:宋体; mso-font-charset:134; mso-generic-font-family:auto; mso-font-format:other; mso-font-pitch:variable; mso-font-signature:1 135135232 16 0 262144 0;} @font-face {font-family:”Cambria Math”; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:1; mso-generic-font-family:roman; mso-font-format:other; mso-font-pitch:variable; mso-font-signature:0 0 0 0 0 0;} @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-1610611985 1073750139 0 0 159 0;} @font-face {font-family:”\@SimSun”; panose-1:0 0 0 0 0 0 0 0 0 0; mso-font-charset:134; mso-generic-font-family:auto; mso-font-format:other; mso-font-pitch:variable; mso-font-signature:1 135135232 16 0 262144 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:”"; margin-top:0in; margin-right:0in; margin-bottom:10.0pt; margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:”Calibri”,”sans-serif”; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:SimSun; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:”Times New Roman”; mso-bidi-theme-font:minor-bidi;} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:SimSun; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:”Times New Roman”; mso-bidi-theme-font:minor-bidi;} .MsoPapDefault {mso-style-type:export-only; margin-bottom:10.0pt; line-height:115%;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} –>
Published July 2008.
In the recent years there has been lot of debate regarding what to do after first episode of anterior dislocation of the shoulder. Opinion ranged from closed reduction followed by 3 weeks immobilization to primary arthroscopic Bankart repair (repair of detached glenoid labrum). Though many surgeons have shown that arthroscopic lavage of the joint alone benefits patients. There are numerous studies which have shown that traumatic anterior dislocation of shoulder is associated with persistent deficit of shoulder function and a high risk of recurrent instability in young adults.
The above mentioned article was published from Edinburgh, United Kingdom. Authors assessed efficacy of primary arthroscopic Bankart repair and also compared the results with arthroscopic lavage. This study is very well designed double blind prospective trial. It included 84 patients aged between 15-35 years.
Authors concluded in this study in Bankart repair group risk of all instability reduced by 82%. The functional scores were better, treatment costs were lower and patient satisfaction was higher after arthroscopic repair. Regarding cost according to authors initial cost is high because of surgery but subsequently because of recurrent instability no. of working days lost and additional procedures are also required. There fore authors recommended early arthroscopic Bankart repair even after first time traumatic anterior dislocation of shoulder.
Further I would invite comments from my orthopedic colleagues regarding this study and its conclusions.