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Double-Sling Augmentation for Anterior Shoulder Dislocation.

ABSTRACT: Anterior capsule ligament deficiency occurs in complicated anterior shoulder dislocation and poses a challenge to surgeons because of the irreparability of the capsule labrum structure or the nonoptimal healing potential after repair. Single-sling augmentation with either conjoined tendon or the long head of the biceps brachii has been reported to enhance the anterior stability of the shoulder. However, single-sling augmentation may still not be enough in cases of complicated anterior shoulder dislocation. Thus we introduce a double-sling anterior shoulder augmentation technique in which both the conjoined tendon and the long head of the biceps brachii are transferred to the anterior inferior side of the glenoid. Our clinical experience indicates that this procedure is effective to address complicated anterior shoulder dislocation. We believe that the introduction of this technique will provide a special choice in the treatment of anterior shoulder dislocation.

SUBMITTER: Zhao J

PROVIDER: S-EPMC7953234 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveTo assess the effects of an additional programme of physiotherapy in adults with a first-time traumatic shoulder dislocation compared with single session of advice, supporting materials, and option to self-refer to physiotherapy.DesignPragmatic, multicentre, randomised controlled trial (ARTISAN).Setting and participantsTrauma research teams at 41 UK NHS Trust sites screened adults with a first time traumatic anterior shoulder dislocation confirmed radiologically, being managed non-operatively. People were excluded if they presented with both shoulders dislocated, had a neurovascular complication, or were considered for surgical management.InterventionsOne session of advice, supporting materials, and option to self-refer to physiotherapy (n=240) was assessed against the same advice and supporting materials and an additional programme of physiotherapy (n=242). Analyses were on an intention-to-treat basis with secondary per protocol analyses.Main outcome measuresThe primary outcome was the Oxford shoulder instability score (a single composite measure of shoulder function), measured six months after treatment allocation. Secondary outcomes included the QuickDASH, EQ-5D-5L, and complications.Results482 participants were recruited from 40 sites in the UK. 354 (73%) participants completed the primary outcome score (n=180 allocated to advice only, n=174 allocated to advice and physiotherapy). Participants were mostly male (66%), with a mean age of 45 years. No significant difference was noted between advice compared with advice and a programme of physiotherapy at six months for the primary intention-to-treat adjusted analysis (between group difference favouring physiotherapy 1.5 (95% confidence interval -0.3 to 3.5)) or at earlier three month and six week timepoints. Complication profiles were similar across the two groups (P>0.05).ConclusionsAn additional programme of current physiotherapy is not superior to advice, supporting materials, and the option to self-refer to physiotherapy.Trial registrationCurrent Controlled Trials ISRCTN63184243.

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Double-Sling Augmentation for Anterior Shoulder Dislocation.

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