AANA/SOMOS Enduring Shoulder Program 2024-21 y.o. Special Operator with First Time Dislocation Dominant Shoulder: Deployment Imminent

Video Transcription

Video Summary

The presentation and debate focus on the management of first-time anterior shoulder dislocation, particularly in young, active individuals like military personnel and athletes. Evidence strongly indicates that surgery, especially arthroscopic Bankart repair possibly combined with remplissage, significantly reduces recurrence rates compared to non-operative treatment. Recurrence rates after non-operative treatment can be as high as 75-90%, whereas surgery lowers this to approximately 11-14%. Young male service members and athletes are at the highest risk, with the military population experiencing rates 15 times higher than civilians.<br /><br />Despite strong evidence favoring early surgical repair, patient values, timing (such as in-season sports or imminent deployment), and functional requirements may warrant a carefully supervised non-operative approach with bracing and rehabilitation. Functional testing in realistic conditions (e.g., full gear for military) is crucial before return to duty or play. Surgery is strongly recommended before a second dislocation due to increased failure rates and complications with revision surgery.<br /><br />Detailed surgical techniques for arthroscopic Bankart repair, including portal placement and anchor fixation, were shared. Emphasis was placed on the importance of experience, patient selection, and timing of surgery for optimal outcomes. The discussion highlighted the complexity of managing shoulder instability in tactical athletes, stressing individualized decision-making balancing evidence, patient priorities, and mission requirements.

Asset Caption

Rehabilitation and Observation (R. Judd Robins, M.D.) vs. Fix It Yesterday (John D. Kelly IV, M.D., FAANA)
Discussion, moderated by Alan S. Curtis, M.D., FAANA
Technique Video: Contemporary Bankart Procedure (Lucas S. McDonald, M.D., M.P.H.T.M., FAANA)

Keywords

anterior shoulder dislocation

arthroscopic Bankart repair

remplissage

recurrence rates

non-operative treatment

military personnel

tactical athletes