ARTHROSCOPIC ASSESSMENT AND THERAPEUTIC OPTIONS AFTER A FIRST EPISODE OF ANTEROMEDIAL SHOULDER TRAUMA IN SUBJECTS AGED LESS THAN 25 YEARS

Abstract

Purpose: The risk of recurrence and progression to chronic instability after a first episode of anteromedial shoulder dislocation is high in young patients. Risk assessment has varied in published reports but is constantly high in subjects aged less than 25 years. The injuries occurring during the first episode are poorly identified and rarely treated. We thus propose an arthroscopic assessment for young subjects with sports activities to identify lesions and achieve stabilisation after the first dislocation. The purpose of this work was to report the lesions observed and present our surgical protocol.

Material and methods: Between February 2002 and March 2003, we included fifteen patients in a prospective study. All patients were aged 17–25 years at the first episode of traumatic anteromedial dislocation of the shoulder. The patients were informed of the “usual” orthpaedic treatment and of the risk of recurrence. We proposed an arthroscopic assessment of their lesions and concomitant treatment. All patients accepted this therapeutic alternative. All procedures were performed by the same operator within ten days of dislocation. Patients were immobilised for 21 days with an elbow to body brace followed by rehabilitation in an outpatient setting, avoiding external rotation for 21 days. The Duplay score was determined.

Results: In this prospective series of patients, we identified a haematoma, a Malgaigne notch, and disinsertion of the anteroinferior capsulolabral complex in all patients. We were unable to find any glenoid or ligament injury on the humerus. The cuff was intact in all patients except one who had a deep wound of the supraspinatus. Lesion suture with resorbable anchors was satisfactory in 14 patients. We have not observed any recurrences. Physical examination did not disclose any apprehension and there has been no case of altered external rotation (< 5).

Conclusion: Considering the major risk of recurrent dislocation after a first episode in these young patients, we have studied an alternative to orthopaedic treatment. All patients accepted the proposed arthroscopic treatment. All patients presented capsulolabral detachment which was easily treated. At last follow-up, all patients have recovered a pain-free stable shoulder. This was a small series with a short follow-up so these results must be considered with caution. They are nevertheless very encouraging.