This document discusses the treatment of first-time shoulder dislocations. It finds that arthroscopic stabilization has lower recurrence rates compared to conservative treatment, especially for young athletes. Arthroscopy allows visualization and repair of common lesions like Bankart tears and Hill-Sachs defects. Studies show arthroscopic stabilization reduces recurrence to 16% versus 47% for conservative care. Arthroscopy provides excellent outcomes with minimal pain and quick return to previous activity levels. It is the recommended approach for young, active patients to prevent future dislocations and allow continued athletic participation.

1. The treatment of first
shoulder dislocation
Manos Antonogiannakis
Director
center for shoulder arthroscopy
IASO gen hospital

2. Winter sports are becoming more popular in Greece
Better and more Ski Centres.
Better organization and equipment
advances turns more people to Winter sports

3. Athletes of every age and level

4. Athletes of all ages

5. Ski injuries 3 per 1000 Skier per day
Hunter RE
Am J Sport Med 1999
Ski injuries 4.33 per 1000 skier per day
Shoulder Injuries 0.51 per 1000 skier per day
Kocher MS Feagin JA
Am J Sport Med 1996

6. The Shoulder
 Greatest Range of Motion in the Body
 Motion in all 3 planes of movement
 Prone to injuries
 8-20% of all sports injuries

7. Shoulder dislocation
2% of the population
90% anterior dislocation

8. First shoulder dislocation is a dramatic event
with dare consequences especially in athletic
individuals

9. 17% to 96% (mean 67%)
Redislocation after acute traumatic
anterior dislocation of the shoulder

10. • Multicenter study
• 245 patients aged 12-40 years
• 10 years follow up
• 52% recurrence rate
• 23% were operated
Prognosis of recurrence after
traumatic first time dislocation
Primary anterior dislocation of the shoulder in
young patients. A 10 year prospective study -
Hovelius 1996 JBJS(A)

11. The major prognostic factor of
recurrence after acute traumatic
anterior shoulder dislocation is the
age of the patient and the degree of
participation to athletic endeavors

12. Redislocation rate in patients < 20 years
Larrain
Rowe
Simonet and Cofield
Slaa
•90%
• 94%
• 94.5%
• 90%

13. Ηovelius, 1996
Athletes hockey on ice
Recurrence rate:
90% in athletes < 20 years old
65% in athletes 20-25 years old
Age and athletic participation

14. The West Point experience
 127 patients
 55 conservative treatment
 Recurrence rate 85%
De Barandino et al. 1996

15. Is shoulder arthroscopy the
best treatment of the first
shoulder dislocation?

16. Arthroscopy in the treatment of
first dislocation
What does it offer?
To what kind of patients?

17. Better understanding of the pathology
Reduction of recurrence rate
Treatment of rotator cuff lesions in older individuals
What does shoulder arthroscopy offers

18. The patient
Young professional athlete
General population
First dislocation in: Athletically oriented
individual
Loose joint individual

19. • Bankart lesion
• Tears of the anterior capsule
• Plastic deformation of the posterior capsule
• Hill-Sachs lesion, Bony Bankart
• rotator cuff tears
• SLAP lesions
Lesions after first
shoulder dislocation

20. Our findings in first shoulder dislocation
 Hemarthrosis 100%
 Bankart 78.2%
 Bony Bankart 13.04%
 Hill-Sachs 65.21%
 capsular laxity 8.69%
 SLAP lesions 21.73%
C. Yiannakopulos E Mataragas E.Antonogiannakis
Arthroscopy Sep 2007

22. Arthroscopic Shoulder
Reconstruction
Goal of the Operation: Define the pathology
Restoration of the Labrum to its anatomic attachment
Reestablishment of the appropriate tension
in the IGHL complex and capsule
Repair bony Bankart and large Hill-Sachs lesions
Repair SLAP lesions
Repair rot cuff tears

23.  EUA
 Arthroscopy
 Suture anchor technique
Treatment of all the lesions
Surgical technique

24. Joint Inspection

25. Arthroscope in Anterior-Superior Portal

26. Mobilization of Anterior Labrum

27. 1st
Anchor Placement

28. suture passage

29. Knot Tying

30. Evaluation of Repair

31. Plication of the posterior capsule

32. SLAP repair

33. Arthroscopic success rate
 Savoie 1997 93%
 Burchart, De Bear 2000 96%
 J Tauro 2000 93%
 Kim 2003 96%
 Snyder 2006 93%
 Fabbriciani 2004 100%

34. Wheeler et al 1989 NO 92% O 22%
Arciero et al 1994 NO 80% O 14%
Arciero et 1995 O 10%
The West Point experience

35.  40 patients
 < 30 years old
 prospective randomized study
 Transglenoid technique
 Same postoperative protocol
 Follow up > 34 months-75months
Arthroscopic stabilization or non operative
treatment for the first shoulder dislocation?
Κirkley et al 1999-2005

36. Sandy Κirkley 1999
Recurrence rate:
Arthroscopic treatment 16%
Conservative treatment 47%
Quality of life (WOSI)
Better in the arthroscopy group
Range of motion
The same with both methods

37. Larrain et al. Arthroscopic repair of acute traumatic anterior shoulder
dislocation in young athletes. Arthroscopy,April 2001
First shoulder dislocation
Young athletes
Transglenoid technique
Follow Up 60 months
Arthroscopic treatment 96 %
excellent results
Conservative treatment 5.5
% excellent results

38. Treatment success
Avoid recurrence
Range of motion
Minor morbidity
Few complication
Return to preinjury activity level
Reproducible results
These are possible with arthroscopic treatment
of the first shoulder dislocation in selected
patients

39. First traumatic shoulder dislocation in patients older than 40
years
Rotator cuff tears 63%
Ribbans et al
JBJS 1990
Different lesions
Different problems to be solved

40. Findings after 1st
shoulder dislocation
in skiers older than 40 years
 52 pts follow up more than 2 years
 Redislocation rate 4%
 Rotator cuff tears 35%
T Penvy, R Hunter, J Freeman
Arthroscopy 1998

41. Conclusions
 The conservative treatment produces a unacceptable
high recurrence rate in young athletic individuals
Arthroscopic treatment has a high success

42.  Arthroscopy can be performed in an
outpatient setting
 The anatomy can be restored with
minimum morbidity and pain for the
patient
 Careful assessment will allow repair
of all lesions after the first
dislocation
Conclusions

43. In older patients rotator cuff tears are
common
The arthroscopic treatment of
symptomatic rotator cuff tears is fissible
with minimum morbidity
ConclusionsConclusions

44. Indications for arthroscopic stabilization of
first shoulder dislocation
• young patients
• professional athletes
• athletically inclined individuals
• dominant shoulder
• avoidance of motion loss
• return to the same activity level
• overhead activity and activity in AB-ER
• rotator cuff tears in older patients

45. Modern arthroscopic techniques
are probably the treatment of choice
in these patients
Conclusions