Early surgical treatment of first-time anterior glenohumeral dislocation in a young, active population is superior to conservative management at long-term follow-up

Abstract

To compare the long-term effectiveness of non-operative treatment with immediate arthroscopic surgical stabilization in young, active patients after first-time anterior glenohumeral dislocation. Consecutive patients aged 15–25 years who suffered primary traumatic anterior glenohumeral dislocation were enrolled in this prospective, non-randomized investigation. In total, 160 patients were enrolled—64 opted for surgical stabilization (group A), while 96 opted for conservative treatment (group B). At final follow-up of over 6.5 years, 60 patients in group A (96.7% males, age 22.8\u2009±\u20093.2) and 70 patients in group B (90.0% males, age 20.8\u2009±\u20092.9) were evaluated with physical examination, patient-reported outcome measures (PROMs), and radiological studies. Recurrence and return to sport (RTS) data were collected, and variables were compared between groups. Recurrence rate in group A was 13.3% at mean latency of 3.3\u2009±\u20091.9 years, compared to 71.4% at mean latency of 2.1\u2009±\u20091.5 years in group B (P\u2009<\u20090.001 for both recurrence rate and latency). In group A, 70.0% of patients RTS at the pre-injury level, versus 41.4% of patients in group B (P\u2009<\u20090.001). Patients in group A scored significantly higher on all PROMs (all P\u2009<\u20090.001) and had significantly less osteoarthritis (P\u2009=\u20090.004), when compared to group B. Acute surgical stabilization of first-time anterior shoulder dislocation in young, active patients is more effective than conservative treatment at long-term follow up, based on lower recurrence rate, better RTS, and higher patient-perceived improvement.