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| |  Early Arthroscopic Bankart Repair Benefits Shoulder Dislocation in Adolescents: Presented at AAP By Nora Steiner Mealy SAN FRANCISCO, CA -- November 1, 2007 -- Arthroscopic Bankart repair (ABR) is an effective primary treatment for traumatically-induced shoulder instability in paediatric patients, according to a retrospective review reported here at the American Academy of Pediatrics (AAP) National Conference and Exhibition. Traumatic anterior shoulder dislocations account for more than 90% of shoulder dislocations and are seen commonly in children who participate in sports. Previous studies have indicated that the risk of recurrent dislocation after the initial injury approaches 95% in patients younger than 25 years. Although the role of ABR for anterior shoulder dislocation has been evaluated before, most studies include paediatric patients within a larger group comprised primarily of adults. Principal investigator Lawrence Wells, MD, Attending Surgeon, Children's Hospital of Philadelphia, and Assistant Professor of Orthopaedics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States, said the inherent instability of a damaged shoulder joint can be compared to a hammock with a broken supporting string. "It's difficult to keep your body inside the hammock," he said. Dr. Wells said he believes that every time a shoulder dislocates, progressive soft tissue attenuation occurs to the point that dislocations may eventually occur even at rest. Dr. Wells said he sees patients who estimate they have had 50 dislocations or "too many to count." In their review, Dr. Wells and colleagues evaluated 32 consecutive ABRs in 30 patients aged 11 to 18 years (mean 15.4 years) with an average follow-up of 25.2 months. Each group -- shoulders that had failed nonoperative therapy prior to ABR and those in which ABR was the primary treatment after initial evaluation -- was comprised of 16 shoulders. Functional outcomes were measured with a single assessment numerical evaluation (SANE) score, in which patients were asked to rate their shoulder function from 0 to 100, with 100 being normal function. In the initial nonoperative therapy group, the average SANE score was 92.2 following ABR, and three shoulder redislocations occurred in two patients (18.75%). In the primary ABR treatment group, the average SANE score was 91.8 and two shoulder redislocations occurred in two patients (12.5%). The study authors concluded that primary ABR is an effective treatment for traumatically induced shoulder instability in paediatric patients and limits multiple recurring dislocations that hinder quality of life. "We currently advocate ABR for primary shoulder dislocation," said Dr. Wells, although he advised that factors such as age, activity level, and mechanism of injury should be taken into account when making treatment decisions.
[Presentation title: Functional Outcomes: Early Arthroscopic Bankart Repair in Adolescents Age 11-18 Years. Abstract 888]
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