Arthroscopic Repair versus Conservative Treatment for first-time Anterior Shoulder Dislocation

Abstract

To systematically compare the clinical efficacy of conservative treatment and arthroscopic one-stage repair for patients with first-time anterior dislocation of the shoulder. A retrieval and systematic review of randomized controlled studies of primary anterior shoulder dislocation with conservative versus arthroscopic repair was conducted and further pooled analysis was performed to compare the overall difference in clinical outcomes, including redislocation and revision surgery rates, shoulder function scores and related complications. Preliminary meta-analysis showed that the risk of anterior shoulder redislocation was 4.73-fold higher in patients treated conservatively than those undergoing arthroscopic repair (RR:4.73 [2.95–7.58], p < 0.000; I² = 0 %, p = 0.920),and that the revision surgery rate was 5.91 times higher in the conservative group than in the arthroscopic repair group (RR:5.91 [2.82–12.39], p < 0.000; I² = 0 %, p = 0.560).Early arthroscopic repair can significantly reduce the redislocation and revision surgery rates and also improve the shoulder joint function score, without serious complications. However, it is necessary to recognize the subset of patients with a higher risk of redislocation in young patients through a high quality, blinded, prospective cohort study when early arthroscopic repair intervention in this subset of high-risk patients will be of significant clinical value.

Zusammenfassung

Systematischer Vergleich der klinischen Wirksamkeit von konservativer Behandlung und arthroskopischer einzeitiger Reparatur bei Patienten mit erstmaliger vorderer Schulterluxation. Es wurde eine retrospektive Analyse von randomisierten kontrollierten Studien zur primären vorderen Schulterluxation mit konservativer versus arthroskopischer Reparatur durchgeführt und die Daten gepoolt, um Unterschiede bei den klinischen Ergebnissen zu vergleichen, einschließlich Redislokations- und Revisionsoperationsraten,

Schulterfunktionswerte und damit verbundene Komplikationen. Eine vorläufige Meta-Analyse zeigte, dass das Risiko einer vorderen Schulter der vorderen Schulter bei konservativ behandelten Patienten 4,73-mal höher war als bei Patienten, die arthroskopisch behandelt wurden (RR:4,73 [2,95–7,58], p < 0,000; I² = 0 %, p = 0,920), und dass die Revisionsoperationsrate in der konservativ behandelten Gruppe 5,91-mal höher war als in der arthroskopischen behandelten Gruppe (RR:5,91 [2,82–12,39], p < 0,000; I² = 0 %, p = 0,560). Eine frühzeitige arthroskopische Reparatur reduziert signifikant die Redislokations- und Revisionsoperationsrate und kann auch den Funktionsscore des Schultergelenks verbessern, ohne ernsthafte Komplikationen. Es ist jedoch notwendig, die Untergruppe der Patienten mit einem höheren Risiko einer Redislokation bei jungen Patienten durch eine qualitativ hochwertige, verblindete, prospektive Kohortenstudie zu identifizieren, wenn eine frühzeitige arthroskopische Intervention bei dieser Subgruppe von Hochrisikopatienten von signifikantem klinischen Wert sein soll.

Keywords

first-time anterior shoulder dislocation - arthroscopy - conservative treatment

Schlüsselwörter

Erstmalige anteriore Schulterluxation - Arthroskopie - konservative Behandlung

Publication History

Received: 23 January 2022

Accepted after revision: 08 November 2022

Article published online:
04 March 2025

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