title: Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder.
abstract: Our purpose was to compare the effectiveness of traditional treatment with immediate arthroscopic stabilization in young patients who have sustained a first traumatic anterior dislocation of the shoulder. Forty skeletally mature patients younger than 30 years of age were randomly allocated to immobilization for 3 weeks followed by rehabilitation (group T) or arthroscopic stabilization (within 4 weeks of injury) followed by an identical immobilization and rehabilitation protocol (group S). A blinded research assistant performed all follow-up evaluations. The dominant arm was involved in 35% of subjects. The injury occurred in a sporting event in 70% of subjects. At 24 months, there was a statistically significant difference in the rate of redislocation (T = 47%, S = 15.9%, P = .03). An intention-to-treat analysis comparing disease-specific quality of life using the validated Western Ontario Shoulder Instability (WOSI) index showed statistically significantly better results in the surgically treated group at the 33 months (T = 633.93 v S = 287.1, P = .03) and no significant difference in range of motion. At an average 32 months follow-up, a significant reduction in redislocation and improvement in disease-specific quality of life is afforded by early arthroscopic stabilization in patients less than 30 year of age with a first, traumatic, anterior dislocation of the shoulder.
authors.affiliation: Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Kirkley
authors.forename: S
authors.initials: S
authors.lastname: Griffin
authors.forename: C
authors.initials: C
authors.lastname: Richards
authors.forename: A
authors.initials: A
authors.lastname: Miniaci
authors.forename: N
authors.initials: N
authors.lastname: Mohtadi
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007103:Immobilization; D008297:Male; D010147:Pain Measurement; D017060:Patient Satisfaction; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D016059:Range of Motion, Articular; D012783:Shoulder Dislocation / Q000209:etiology / Q000534:rehabilitation* / Q000601:surgery*; D016896:Treatment Outcome