Review of Arciero's article (1994) on arthroscopic Bankart repair versus non-operative treatment for acute, initial anterior shoulder dislocations: does the same hold true in 2016?

Abstract

This classic reexamines the landmark publication ‘Arthroscopic Bankart repair versus non-operative treatment for acute, initial anterior shoulder dislocations’ by Arciero et al, published in 1994 in The American Journal of Sports Medicine. The authors provided pertinent evidence to support the use of arthroscopy to repair associated Bankart lesions found after acute, initial anterior shoulder dislocations in the young, athletic patient population. The recommendations put forth were a departure from the established teachings at the time. The article demonstrated a significantly reduced rate of recurrence after arthroscopic stabilisation compared with non-operative management in US Military Academy cadets. The majority of patients who failed non-operative treatment required subsequent open repair. At the time of arthroscopy, a Bankart lesion was diagnosed in all patients, which the authors postulated are consistently present after acute first-time dislocations. The authors concluded that in young athletes, particularly in this case, military cadets, return to previous levels of activity and training is imperative. These findings remain relevant today and provided the impetus for the evolution in surgical techniques and implants over the past 20 years. Subsequent randomised controlled trials have largely supported the use of arthroscopic stabilisation in the young, high-demand population. Other subsequent studies have further reviewed the risk factors for failure after surgery to continue to refine the treatment algorithm. The treatment of initial anterior dislocations of the shoulder remains a challenging endeavour, with an ever-expanding list of options. This classic work challenged the established treatment approach in a particular patient group, the young athlete. The teachings imparted in the article, and reiterated in subsequent research studies, have taught us treatment decisions should be personalised and formulated on an individual basis.