Controversial shoulder surgery effective long-term

Young, athletic, first-time shoulder dislocation patients benefit from arthroscopic surgery long term, as per a research studyreleased recently at the 2008 American Orthopaedic Society for Sports Medicine Specialty Day at The Moscone Center. The study observed that for highly active patients, surgery, rather than conservative methods, yielded excellent results.

In young, active patients, there were statistics as high as 92 percent that they would dislocate their shoulder again when conservative approaches like rest and immobilization in a sling were used, says Robert A. Arciero, MD, of the Keller Army Hospital in West Point, NY. If we had an operation with a 90 percent failure rate, we would abandon the procedure. My thought was, why should we embrace a therapy with such a high failure rate".

Beginning in 1993, Dr. Arciero began performing arthroscopic surgery on young military cadets who suffered their first shoulder dislocation. The short-term results were excellent. The unknown, however, was how these patients would fare over the years.

We decided to examine these patients long-term results, says Major Brett Owens, MD, of Williams Beaumont Army Medical Center in El Paso, Texas. We observed that these patients maintained their health and active lifestyle. Surgery for this group of patients was durable and provided excellent shoulder function and a high activity level even after 10 years.

Owens and colleagues reviewed 39 patients (40 shoulder operations) whose follow-up averaged 11.7 years. Patients were reviewed with patient-derived outcomes measures and asked to compare their repaired shoulder to its function level pre-injury and whether they would be likely to have the surgery again. Additionally, they were physically assessed with many tests, including, how a number of push-ups they completed in two minutes and performance on the Army Physical Fitness Test.

Overall, the study observed that the patients maintained excellent use of their shoulder. The mean American Shoulder and Elbow Surgeons score was 90.9. The patients compared their repaired shoulders function to the pre-injury function. The average response was 93 percent, the study found. When responding to whether they would have the surgery again with 10 being very likely, the average score was 9.1, as per the study.

In terms of athletic ability, the results were also notable. The study found the average number of push-ups performed in 2 minutes was 72.8 in comparison to 77.7 previous to their injuries. The mean score of the Army Physical Fitness Test was 282.2 out of a possible 300, as per the study.

The study also noted five patients who had eight further dislocations, all of which occurred during athletic activity, for a failure rate of 10 percent long-term.

Certainly our study proves that for this group of patients, young, athletic cadets unable to modify their activity level, arthroscopic surgery for first-time dislocations is successful both short and long-term, says Dr. Owens. This therapy allowed our patients to return to sports, graduate from the military academy and engage in active duty military obligations. It may not be the approach that should be taken for a person who lives a sedentary lifestyle, but this could be applicable to the young, 15-25-year-old athlete, who is at high risk for recurrent instability and compromised function.


Posted by: Sean    Source