This trial is evaluating whether Arthroscopic Bankart repair procedure will improve 3 primary outcomes and 21 secondary outcomes in patients with Shoulder Dislocation. Measurement will happen over the course of 24 months after surgery.
This trial requires 400 total participants across 3 different treatment groups
This trial involves 3 different treatments. Arthroscopic Bankart Repair Procedure is the primary treatment being studied. Participants will be divided into 3 treatment groups. There is no placebo group. The treatments being tested are not being studied for commercial purposes.
For shoulder dislocations in general, and proximal dislocation specifically, the incidence was not as high as 10%. Patients with shoulder dislocations should receive immediate and thorough clinical evaluation in order to minimize the risk of long-term disability. Appropriate referral to shoulder surgery is essential for patients with proximal dislocation.
Treatment for shoulder dislocation can sometimes be conservative. In other cases, an operation may be required. Patients should be kept immobilized while awaiting the results of diagnostic imaging after a shoulder dislocation. Surgery is usually not needed to treat shoulder dislocation, but a shoulder immobilizer or a sling may be kept in place until the dislocation resolves. Surgeons often recommend surgery when the shoulder is dislocated more than 2-3 times in the previous year and to prevent a fracture of the reverse shoulder. If surgery is performed, it is often followed by physiotherapy to help recover the full range of motion of the shoulder within about 6 to 8 weeks.
A total of approximately 15,000 shoulder dislocations occur each year in the United States. Furthermore, the incidence of shoulder dislocations is higher in women and in the young.
An increase in pain, swelling or deformity is commonly (70%) reported following shoulder dislocation. Analgesic use alone tends to relieve only an estimated 20 to 30% of pain. Surgical options are available to relieve this pain in most cases. However, these are fraught with a high rate of complications and long hospitalizations.
There are multiple causes that contribute to shoulder injuries in adolescents and the mechanism of shoulder dislocation in young patients is different from that of adults. Adolescent patients may be at higher risk for shoulder injuries through specific risk factors.
Despite some optimistic results from experimental studies, including earlier studies of the effects of anteroposterior shoulder dislocation on the shoulder joint, it appears that the shoulder cannot be cured. Although functional outcomes, including the ability to return to activities of daily living, can be improved with shoulder dislocation, they are not sufficiently excellent to equate with complete reconstruction of the anatomical integrity of the shoulder joint.
There is no significant difference in the incidence of redisplaced shoulder dislocation amongst the age groups. The shoulder dislocation with open and closed reduction in the same day is also not statistically significant. So, patients with shoulder dislocation should not be treated as urgent and be sent to the emergency room to reduce the dislocation overnight. To prevent recurrent dislocations in the future, patients can be instructed on the correct posture and movements to reduce a possible dislocation. We can also educate patients on the proper shoulder positioning and movements to minimize the chances of inducing a dislocational episode. Patients can also be instructed to not roll the arm over on the back.
There is a growing body of evidence that suggests that the arthroscopic Bankart arthroplasty with the screw-in anchors has better postoperative results even when compared with the conventional Bankart arthroplasty method. There is no evidence that a minimally invasive technique may yield increased morbidity or mortality compared with the conventional Bankart arthroplasty. The main disadvantage of the screw-in anchor technique is the increased necessity for postoperative rehabilitation.
Arthroscopic Bankart repair, with autoloike structures preservation and tendon remodeling, was found to be more effective than a placebo. This procedure did not appear to increase the risk on postoperative shoulder pain.
For shoulder dislocation which is refractory to conservative interventions, conservative therapy should be combined with surgical intervention. However, the long-term effect of surgical intervention is worse than conservative therapy for shoulder dislocation. If patients have no other medical problems, nonoperative treatment should be taken into consideration.
The common side effects of arthroscopic bankart repair include shoulder discomfort, ecchymosis, transient hypotension, transient brachial plexus palsy, shoulder pain, numbness, etc. Some authors propose that they are tolerable. Nevertheless, all of the above-mentioned side effects may be improved through better surgical technique, such as increased-size anchors placement.
Findings from a recent study shows that the risk of a first shoulder dislocation among relatives of shoulder dislocation patients is relatively high. Although the risk of shoulder dislocation in relatives is lower than observed that of the index patient, this result supports the concept that shoulder dislocations are familial at least in part.