Arthroscopic versus nonoperative treatment of acute shoulder dislocations in young athletes

We evaluated the natural history of anterior shoulder dislocations in a young athletic population (cadets at the United States Military Academy) and compared conventional means of nonoperative treatment with early arthroscopic treatment (staple capsulorraphy or anterior glenoid abrasion). The rate of recurrent instability after a shoulder dislocation was 92% (35 of 38) in cadets treated nonoperatively. Strict adherence to a supervised nonoperative treatment program had no effect on the recurrence rate. All recurrences of instability occurred within 14 months of the initial injury. In comparison, arthroscopic treatment of acute shoulder dislocations has been successful thus far in 78% (7 of 9) of cadets followed for at least 14 months. With the high rate of recurrence of shoulder instability in young athletes, we believe that arthroscopic surgical intervention after the initial shoulder dislocation can dramatically lower the recurrence rate and should be considered as a treatment option in young athletes.