Elsevier

Journal of Shoulder and Elbow Surgery

Volume 12, Issue 6, November–December 2003, Pages 529-534
Journal of Shoulder and Elbow Surgery

Original article
A prospective arthroscopic study of acute first-time anterior shoulder dislocation in the young: a five-year follow-up study

https://doi.org/10.1016/S1058-2746(03)00218-0Get rights and content

Abstract

A prospective arthroscopic study was conducted on 31 patients with an acute first-time anterior shoulder dislocation (AFASD). The patients were aged between 16 and 39 years. The mean age was 24 years. None had a history of shoulder problems. All were evaluated after 1, 2, and 5 years. The Constant score, Rowe score, recurrence rate, and instability rate were evaluated, as well as patient satisfaction and sports participation. We conclude that after a prolonged follow-up, an increase in the instability rate in young patients with AFASD may become apparent. The overall instability rate was 55% (17/31) after 5-year follow-up. In patients aged younger than 18 years the instability rate was 71% (5/7). Age was the only predictive factor in shoulder instability. The mean Rowe score was 87 (range, 57-100; SD, 14). Three patients had undergone a stabilization operation at the 5-year follow-up. The intraarticular pathology found at arthroscopy was not predictive of shoulder instability. We could not find a correlation between sporting activities and shoulder instability. On the basis of our results, it appears unlikely that arthroscopic lavage reduces redislocation rates after AFASD in the young patient.

Section snippets

Materials and methods

From January 1991 to July 1994, we treated 105 patients with 107 AFASDs in the emergency department of our regional, university-affiliated hospital. Thirty-one patients with AFASD were included in this study. They all met the following inclusion criteria: (1) an AFASD, (2) age between 15 and 40 years, (3) dislocation without fracture, and (4) no history of shoulder problems. All patients gave informed consent.

Of the 105 patients, 50 were aged older than 40 years, 7 had fractures (5 greater

Recurrence and instability

At 1 year of follow-up, 1 patient had a recurrence (after 7 months), and 2 patients had subluxations. The instability rate was 7% (2/31). The mean Constant score was 99 (range, 95-100; SD, 1.7), and the mean Rowe score was 98 (range, 67-100; SD, 6.5) (Table I).

At 2 years of follow-up, we found 6 recurrences and 8 subluxations. Four patients had recurrences and subluxations. On average, recurrences occurred at 14 months (range, 7-20 months) after the first dislocation. Of the 6 patients with

Discussion

Redislocation of the shoulder is the most frequent complication of the AFASD. Several studies have shown that the age of the patient at the time of AFASD is the most important factor in predicting the risk of redislocation.12, 14, 15, 16, 20, 28, 30, 33, 36, 37 In our study we also found that age was the most important prognostic factor in recurrent shoulder instability. In patients aged younger than 18 years the instability rate after 5 years of follow-up was 71% (5/7), compared with 55% for

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