Interest of emergency arthroscopic stabilization in primary shoulder dislocation in young athletes

Introduction: The recurrence rate after primary shoulder dislocation in young subjects with high functional demand is close to 75%. The present study assessed the interest of emergency arthroscopic stabilization in this specific population. Material and methods: A non-randomized prospective study included 31 athletes under 30 years of age with primary anterior shoulder dislocation. Fifteen were offered emergency stabilization; after informed consent, 14 were enrolled in the ``emergency stabilization'' group. This was compared to a group matched for age, sport and lesion, managed 1 year previously by ``non-operative'' treatment (n = 17), divided into 2 subgroups: ``immobilization'' and ``secondary stabilization''. Continuous prospective assessment of recurrence, return to sport and function (QuickDASH, QDsport, Duplay and Rowe scores) enabled comparison between the 3 groups. Results: Mean follow-up was 19 months for the ``emergency stabilization'' group and 25 months for the ``non-operative'' group. There were no failures in the ``emergency stabilization'' group, compared to a 77% rate in the ``non-operative'' group with onset at a mean 7.5 months and a mean 2.6 episodes of recurrence. Seven (54%) of the failures of non-operative treatment required secondary stabilization. Ninety-three percent of the ``emergency stabilization'' group, 44% of the ``immobilization'' group and 71% of the ``secondary stabilization'' group resumed sport at least at their pre-dislocation level. Mean Quick DASH was 1.46 in the ``emergency stabilization'' group, versus 15.28 the ``immobilization'' group (P < 0.05) and 16.96 in the ``secondary stabilization'' group. Mean Duplay and Rowe scores were respectively 92.9 and 95 in the ``emergency stabilization'' group, versus 59.44 and 61.1 in the ``immobilization'' group (P < 0.05) and 85 and 93.57 in the ``secondary stabilization'' group. Discussion: Emergency arthroscopic stabilization limits recurrence (Kirkley et al.), with better functional results than for secondary stabilization, lesion ``freshness'' providing a more favorable environment for labral and ligamentary healing. These encouraging results need confirmation over longer follow-up. (C) 2014 Elsevier Masson SAS. All rights reserved.