Results in arthroscopic treatments after acute dislocation compared with results in chronic dislocation repair.

Recent studies have demonstrated that the arthroscopic treatment after first dislocation of the shoulder can improve the percentage of good results, decrease the number of further dislocation, avoid the open treatment and the evolution in chronic instability. The treatment of the first episode is more indicated in young people, with high request for sport and work activity. The aim of this paper is to compare the result of the arthroscopic treatment after first dislocation with those of multiple dislocations. Materials and methods From 2004 to 2009 we treated arthroscopically two groups of patients. The first group, after single dislocation, 63 patients with a mean age of 21 (range 18–24), with high sports performances and work demand; in the second group 90 patients with a mean age of 28 (range 17–40), after multiple dislocations, with no demand of high performance of the shoulder. All the patients were studied with X-rays and MRI pre-operation exams. All patients were evaluated with Rowe Scale Evaluation schedule. Minimum follow up was 2 years and the post-operative protocol was the same for the two groups. Results Follow-up ranged from 2 to 8 years. In the first group good results were the 90.8 %, in the second 84.5 %. No rate of re-dislocation in the first group, 2 patients (9.2 %) had moderate instability and apprehension and they did not return to the previous level of sport and work performance. In the second group we reported bad results in the 15.5 % with the rate of re-dislocation of 8 %. We reported higher percentage of slap lesion in the first group (23.8 %) compared with the second one (11.1 %). Discussion Two important factors were reported as correlated with the increase of anatomical damages in the first group: the high energy trauma and the surgical timing after the single episode. In the second group we reported worse capsular tissue quality, higher rate of ‘‘engaging Hill Sachs lesions’’ (16 %), not observed in the first group. In the first group we observed more damages in the anterior and superior capsular structures, in the second group more anterior and inferior damages. Conclusions The arthroscopic treatment after first dislocation is associated with high percentage of good results, it can decrease the rate of re-dislocation in young active patients with high request of sport and work performance. This is a sure indication in this population. We can avoid the evolution in chronic instability and decrease damages of the anatomical structures.