Single anterior shoulder dislocation patients demonstrate higher rates of posterior labral repair and biceps procedures than multiple dislocators at the time of arthroscopic stabilization surgery

Abstract

IntroductionThe purpose of this study is to identify and compare demographic, clinical, historical, and intra-operative variables in patients who have received arthroscopic treatment for single versus multiple anterior shoulder dislocations. MethodsThis is a retrospective chart review of patients who underwent arthroscopic labral repair of the shoulder by six surgeons at a single institution between 2012-2020. Patients with a documented anterior shoulder dislocation were included. Patients with pain-only, subluxation-only, multi-directional or posterior instability, and prior shoulder surgeries of any kind were excluded. Studied variables included age, sex, laterality, body mass index, contact/collision sports, Charlson Comorbidity Index, tobacco use, number of dislocations (1, >1), labral tear size, time from first dislocation to surgery, anchor number, and concomitant procedures. Study groups were compared using student’s t-tests and Mann-Whitney U test for continuous variables and Chi-Square or Fisher’s Exact tests for discrete variables with a significance of 0.05. Results633 patients were identified and 351 [85 single dislocators (SD), 266 multiple dislocators (MD)] met inclusion criteria (mean age: 27 years; range: 14-71 years). There were no demographic differences between study groups. SD received surgery significantly sooner at 17 ± 44 months after injury, while MD received surgery 53 ± 74 months post-initial dislocation. SD (30/85, 35%) were significantly more likely than MD (56/266, 21%) to receive concomitant posterior labrum repair. MD (46/266, 17%) were significantly more likely than SD (5/85, 6%) to receive a Remplissage. SD (11/85, 13%) were significantly more likely than MD (11/266, 4%) to receive a concomitant biceps tenotomy/tenodesis. There were no other significant differences in injury or surgery characteristics. ConclusionMD will have more time between their initial dislocation and arthroscopic labral repair and were more likely to receive a Remplissage procedure, yet were less likely than SD to receive a concomitant posterior labral repair or biceps tenodesis/tenotomy despite no differences in age, sex, and activity level. Whether the greater extent of labrum injury in SD is due to a more severe initial injury versus earlier recognition and intervention requires further study.