Natural History of First-Time Anterior Shoulder Dislocation in Patients Older Than 50 Years: A Study of 179 Patients With a Mean Follow-up of 11 Years

Anne A Smartt, Ryan R Wilbur, Bryant M Song, Aaron J Krych, Kelechi Okoroha, Jonathan D Barlow, Christopher L Camp, Anne A Smartt, Ryan R Wilbur, Bryant M Song, Aaron J Krych, Kelechi Okoroha, Jonathan D Barlow, Christopher L Camp

Abstract

Background: There is a dearth of knowledge on anterior shoulder instability in older patients.

Purpose/hypothesis: The purposes of this study were to describe the incidence and epidemiology, injury characteristics, and treatment and outcomes in patients ≥50 years old with first-time anterior shoulder instability. We also describe the historical trends in diagnosis and treatment. It was hypothesized that the rates of obtaining a magnetic resonance imaging (MRI) scan and surgical intervention have increased over the past 20 years.

Study design: Descriptive epidemiology study.

Methods: An established geographic database was used to identify 179 patients older than 50 years who experienced new onset anterior shoulder instability between 1994 and 2016. Medical records were reviewed to obtain patient characteristics, imaging characteristics, and surgical treatment and outcomes, including recurrent instability. Comparative analysis was performed to identify differences between age groups. Mean follow-up time was 11 years.

Results: The incidence of first-time anterior shoulder dislocation in our study population was 28.8 per 100,000 person-years, which is higher than previously reported. Full-thickness rotator cuff tears were found in 62% of the 66 patients who underwent MRI scans. Of all patients, 26% progressed to surgery at a mean time of 1.6 years after injury; 57% of all surgical procedures involved a rotator cuff repair, and 17% included anterior labral repair. All patients who underwent a labral repair also underwent concomitant rotator cuff repair. The rate of recurrent instability for the cohort was 15% at a median of 176 days after the initial instability event. There were no instances of recurrent instability after operative intervention. At an average of 7.5 years after the initial instability event, 14% of patients developed radiographic progression of glenohumeral arthritis. The rate of surgical intervention within 1 year of initial dislocation increased from 5.1% in 1994 to 1999 to 52% in 2015 to 2016.

Conclusion: The incidence of first-time anterior shoulder instability in patients aged ≥50 years was 28.8 per 100,000 person-years. Full-thickness rotator cuff tears (62%) were the most common condition associated with anterior shoulder instability, followed by Hill-Sachs lesions (56%). The rate of recurrent instability for the entire cohort was 15%, with no instances of recurrent instability after operative intervention.

Keywords: anterior shoulder instability; dislocation; recurrent instability; rotator cuff tear.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: Support was received from the Foderaro-Quattrone Musculoskeletal Orthopaedic Surgery Research Innovation Fund. Funding was received from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program (T32AR56950). The Rochester Epidemiology Project (REP) medical records-linkage system is supported by the National Institute of Aging (AG 058738), by the Mayo Clinic Research Committee, and by fees paid annually by REP users. A.J.K. has received grant support from DJO; consulting fees from Arthrex, JRF Ortho, and Responsive Arthroscopy; speaking fees from Arthrex; royalties from Arthrex and Responsive Arthroscopy; and honoraria from JRF Ortho and Vericel; and he is a board member for MTF Biologics. K.O. has received grant support from Arthrex; education payments from Arthrex and Smith & Nephew; consulting fees from Endo Pharmaceuticals and Smith & Nephew; speaking fees from Arthrex; and hospitality payments from Medical Device Business Services, Stryker, and Wright Medical. J.D.B. has received education payments from CDC Medical, consulting fees from Stryker, speaking fees from Arthrex, and hospitality payments from Wright Medical. C.L.C. has received nonconsulting fees from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2022.

Figures

Figure 1.
Figure 1.
Incidence of anterior instability by age (years).
Figure 2.
Figure 2.
Radiographic findings by age at first-time anterior shoulder dislocation. Radiographs were not available for 47 patients.
Figure 3.
Figure 3.
Magnetic resonance imaging findings by age at first-time anterior shoulder dislocation.
Figure 4.
Figure 4.
Types of surgical treatment, 1994 to 2016. Some patients underwent >1 procedure, and 3 patients did not fit the criteria of RCR, labral repair, ORIF, or arthroplasty. ORIF, open reduction and internal fixation; RCR, rotator cuff repair..
Figure 5.
Figure 5.
Rates of magnetic resonance imaging (MRI) at 30 days, 90 days, and 1 year after first-time anterior shoulder dislocation, 1994 to 2016.
Figure 6.
Figure 6.
Rates of surgical intervention for first-time anterior shoulder dislocation at 30 days, 90 days, and 1-year, 1994 to 2016.

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Source: PubMed

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