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High failure rate after conservative treatment for recurrent shoulder dislocation without subjective apprehension on physical examination

Authors
 Woo-Sung Do  ;  Joo-Hyung Kim  ;  Joon-Ryul Lim  ;  Tae-Hwan Yoon  ;  Seung-Hwan Shin  ;  Yong-Min Chun 
Citation
 KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol.31(1) : 178-184, 2023-01 
Journal Title
KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY
ISSN
 0942-2056 
Issue Date
2023-01
MeSH
Arthroscopy / methods ; Conservative Treatment ; Humans ; Joint Instability* / etiology ; Joint Instability* / surgery ; Physical Examination ; Recurrence ; Retrospective Studies ; Shoulder Dislocation* / diagnosis ; Shoulder Dislocation* / surgery ; Shoulder Joint* / surgery
Keywords
Apprehension ; Bankart lesion ; Conservative treatment ; Instability ; Shoulder
Abstract
Purpose: The purpose of this study was to investigate the outcomes of conservative treatment for recurrent shoulder dislocation without subjective apprehension, despite the presence of a Bankart lesion or glenoid defect.

Methods: A retrospective analysis was performed for 92 patients with recurrent shoulder dislocation treated with conservative treatment due to negative apprehension between 2009 and 2018. The failure of the conservative treatment was defined as a dislocation or subluxation episode or subjective feeling of instability based on a positive apprehension. The Kaplan-Meier method was used to estimate failure rates over time, and a receiver operating characteristic (ROC) curve was constructed to determine a cut-off value for a glenoid defect. The clinical outcomes were compared between patients who completed conservative treatment without recurrence of instability (Group A) and those who failed and subsequently underwent surgical treatment (Group B) using shoulder functional scores and sports/recreation activity level.

Results: This retrospective study included 61 of 92 eligible patients with recurrent shoulder dislocation. Among the 61 patients, conservative treatment failed in 46 (75.4%) over the 2-year study period. The cut-off value for a glenoid defect was 14.4%. The association between glenoid defect size (≥ 14.4% or as a continuous variable) and survival was statistically significant (p = 0.039 and p < 0.001, respectively). The mean glenoid defect size in Group B increased from 14.6 ± 3.0% to 17.3 ± 3.1% (p < 0.001), and clinical outcomes for Group A were inferior to those for Group B at the 24-month follow-up.

Conclusions: Conservative treatment for recurrent shoulder dislocation in patients without subjective apprehension showed a high failure rate during the study period, especially if the glenoid defect was ≥ 14.4% in size. Despite clinical improvement in patients who completed conservative treatment without recurrence, functional outcome scores and sport/recreation activity levels were better in the patients who underwent arthroscopic Bankart repair. Therefore, for recurrent anterior shoulder instability, even without subjective apprehension, surgical treatment is warranted over conservative treatment.
Full Text
https://link.springer.com/article/10.1007/s00167-022-07028-w
DOI
10.1007/s00167-022-07028-w
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Do, Woo Sung(도우성)
Yoon, Tae Hwan(윤태환) ORCID logo https://orcid.org/0000-0002-2859-5240
Lim, Joon Ryul(임준열) ORCID logo https://orcid.org/0000-0002-0123-7136
Chun, Yong Min(천용민) ORCID logo https://orcid.org/0000-0002-8147-6136
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/197688
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