Arthroscopic Bankart Repair Versus Immobilization for a First Episode of an Anterior Shoulder Dislocation Before the Age of 25 Years: A Randomized Controlled Trial With 6-Year Follow-up
Notice bibliographique
Résumé
Background: The risk of recurrence after a first episode of an anterior shoulder dislocation (ASD) is high with nonoperative treatment in younger patients. In a previous study, arthroscopic labral repair (Bankart repair) reduced the risk of secondary shoulder dislocations and improved functional outcomes versus nonoperative treatment at 2-year follow-up. Purpose/Hypothesis: The aim of this study was to compare the results of arthroscopic Bankart repair and nonoperative treatment at a minimum of 6 years’ follow-up in patients aged ≤25 years. The hypothesis was that acute surgery would decrease the risk of recurrence and improve functional outcomes. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: We included patients aged between 18 and 25 years after a first episode of an ASD and divided them into 2 groups. The first group was treated surgically with arthroscopic Bankart repair in the initial 2 weeks after the dislocation, and the second group was treated nonoperatively. Both groups were immobilized for 3 weeks in internal rotation and followed the same physical therapy protocol. Follow-up was performed at a minimum of 6 years. The primary outcome measure was the recurrence of instability, defined as another ASD requiring closed reduction or a subluxation. Secondary outcome measures included the need for stabilization surgery; return to sport; and functional outcomes according to the quick version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), Walch-Duplay score, and Western Ontario Shoulder Instability Index (WOSI). Results: There were 20 patients included in each group. The mean age at the time of inclusion was 21.4 ± 1.8 years. A total of 37 patients were evaluated at a mean follow-up of 81.4 months (6.8 years). In the surgical group, the recurrence of instability (dislocation or subluxation) was significantly lower compared with the nonoperative group (n = 5 [27.8%] vs 17 [89.5%], respectively; P < .0005), and the rate increased in both groups compared with 2-year results (n = 2 [10%] vs 13 [65%], respectively; P = .003). Fewer patients had another episode of a dislocation in the surgical group compared with the nonoperative group (n = 4 [22.2%] vs 15 [79.0%], respectively; P < .003). In the surgical group, all dislocations occurred after 2 years’ follow-up, while 6 patients in the nonoperative group already had dislocations at 2 years. The Walch-Duplay score (93.24 vs 76.05 points, respectively; P = .0004), WOSI score (12.12 vs 20.95 points, respectively; P = .009), and QuickDASH score (4.84 vs 16.14 points, respectively; P = .0088) were significantly better in the surgical group than in the nonoperative group. The rate of return to the same or better level of sport was 82% in the surgical group compared with 21% in the nonoperative group ( P < .0009). Additionally, 11 patients (29.7%) required primary or secondary shoulder stabilization surgery: 2 (11.1%) in the surgical group and 9 (47.4%) in the nonoperative group ( P < .04). Conclusion: Arthroscopic labral repair (Bankart repair) reduced the risk of secondary shoulder dislocations and improved functional outcomes versus nonoperative treatment at 6-year follow-up. Surgical treatment after a first episode of a shoulder dislocation could be offered as a primary treatment option in a younger population. Registration: NCT03315819 (ClinicalTrials.gov)
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,008 | 0,005 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,004 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».