Editorial Commentary: Management of First-Time Anterior Shoulder Instability Requires Risk Stratification and Surgery for Many, But Not All
| Autor: | Ujash Sheth |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
musculoskeletal diseases
Joint Instability Male medicine.medical_specialty Shoulder Risk Assessment Article Arthroscopy Recurrence Medicine Humans Orthopedics and Sports Medicine Rotator cuff Recurrent instability Risk factor Subluxation business.industry Inferior glenohumeral ligament Shoulder Joint Shoulder Dislocation Glenohumeral joint capsule Anterior shoulder medicine.disease Surgery medicine.anatomical_structure Risk stratification business |
| Zdroj: | Arthroscopy |
| ISSN: | 1526-3231 |
| Popis: | PURPOSE: To define the success rate of initial non-operative treatment for traumatic anterior shoulder instability in a defined US geographic population, describe factors that predict conversion to surgery after initial non-operative management, and describe the long-term outcomes of non-operative treatment following index traumatic anterior instability event. METHODS: The Rochester Epidemiology Project database was utilized to identify patients –14 – 39 years of age treated for anterior shoulder instability between 1994 and 2016. Patient demographics, comorbidities, injury characteristics, and imaging were evaluated. Patients treated non-operatively for the first 6 months following index instability event were analyzed to determine long-term outcomes (recurrence rates, pain at last follow up, radiographic outcomes), success rate of continued non-operative treatment (no conversion to surgery), and factors associated with conversion to surgery (patient and injury characteristics). Survivorship free of surgery was reported with a Kaplan-Meier survival curve and Cox proportional hazard models were utilized to evaluate association of variables with conversion to surgery. RESULTS: 379 patients met criteria with an average follow-up of 10.2 years (range 0.53 to 25.00). Average age was 23.9, mean BMI was 26.2, and 100% of instability events were due to trauma. 79 shoulders (20.1%) ultimately failed initial non-operative treatment and progressed to surgery. At final follow-up, the rate of recurrent instability was 52.3% in the group treated definitively without surgery, and recurrence rates decreased from 92.4% to 10.1% in those who converted to surgical treatment. Factors associated with conversion to surgery included 2 or more subluxations prior to first evaluation (HR=1.82, p=0.002), 2 or more dislocations prior to first evaluation (HR=1.76, p=0.006), and recurrent instability at follow-up (HR=4.21, p |
| Databáze: | OpenAIRE |
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