Open AccessConservative treatment of acute traumatic posterior shoulder dislocations (Type A) is a viable option especially in patients with centred joint, low gamma angle, and middle or old age
Author(s) -
Festbaum Christian,
Minkus Marvin,
Akgün Doruk,
Hupperich Andreas,
Maier Dirk,
Auffarth Alexander,
Mitterer Marian,
Hoffelner Thomas,
Tauber Mark,
Fritsch Lorenz,
Moroder Philipp
Publication year - 2022
Publication title -
knee surgery, sports traumatology, arthroscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.806
H-Index - 125
eISSN - 1433-7347
pISSN - 0942-2056
DOI - 10.1007/s00167-022-06883-x
Subject(s) - medicine , shoulders , subluxation , magnetic resonance imaging , surgery , shoulder joint , retrospective cohort study , radiological weapon , conservative treatment , radiology , alternative medicine , pathology
Purpose Purpose of this study was to evaluate the mid‐ to long‐term outcome after conservatively treated first‐time posterior shoulder dislocations and to determine structural defects associated with failure. Methods In this multi‐centric retrospective study, 29 shoulders in 28 patients with first‐time acute posterior shoulder dislocation (Type A1 or A2 according to the ABC classification) and available cross‐sectional imaging were included. Outcome scores as well as radiological and magnetic resonance imaging were obtained at a mean follow‐up of 8.3 ± 2.7 years (minimum: 5 years). The association of structural defects with redislocation, need for secondary surgery, and inferior clinical outcomes were analysed. Results Redislocation occurred in six (21%) shoulders and nine shoulders (31%) underwent secondary surgery due to persistent symptoms. The posttraumatic posterior glenohumeral subluxation was higher in the redislocation group compared to the no redislocation group; however, statistical significance was not reached (61.9 ± 12.5% vs. 50.6 ± 6.4%). Furthermore, a higher adapted gamma angle was observed in the failed conservative treatment group versus the conservative treatment group, similarly without statistically significant difference (97.8° ± 7.2°, vs. 93.3° ± 9.7°). The adapted gamma angle was higher than 90° in all patients of failed conservative therapy and the redislocation group. An older age at the time of dislocation showed a significant correlation with better clinical outcomes (SSV: r = 0.543, p = 0.02; ROWE: r = 0.418, p = 0.035 and WOSI: r = 0.478, p = 0.045). Posterior glenohumeral subluxation after trauma correlated with a worse WOSI ( r = − 0.59, p = 0.02) and follow‐up posterior glenohumeral decentring ( r = 0.68, p = 0.007). The gamma angle ( r = 0.396, p = 0.039) and depth of the reverse Hill–Sachs lesion ( r = 0.437, p = 0.023) correlated significantly with the grade of osteoarthritis at follow‐up. Conclusion Conservative treatment is a viable option in patients with an acute traumatic posterior shoulder dislocation with good outcome after mid‐ and long‐term follow‐up especially in patients with centred joint, low gamma angle, and middle or old age. Level of evidence IV.