Evaluation of surgical management strategies for chronic anterior shoulder dislocations: a retrospective analysis of 34 patients

Abstract

Background: Chronic anterior shoulder dislocations are uncommon; however, they pose a substantial challenge and necessitate a complex treatment decision-making process. This study aims to contribute to the existing literature by examining the surgical treatment outcomes of chronic anterior shoulder dislocations, focusing on surgical treatment methods and outcome measures.

Methods: This retrospective study analysed prospectively collected data from 34 patients with chronic anterior shoulder dislocations treated between February 2020 and December 2022. Four surgical procedures were reviewed: open reduction and rotator cuff and/or capsulolabral repair (n = 7); open reduction and Latarjet procedure (n = 7); open reduction and iliac crest autograft (n = 9); and reverse shoulder arthroplasty (RSA) (n = 11).

Results: The mean age of patients was 67 years, with 65% male. Falls were the most common cause of injury (68%). The average time from dislocation to relocation in this cohort was 28 weeks. Preoperative evaluations revealed delayed presentation due to self-neglect and healthcare access issues, with 41% misdiagnosed initially. Surgical interventions varied, with an average follow-up of 14 months (range: 3–52). RSA showed excellent patient-reported outcomes ratings, measured by the Oxford Shoulder Score (OSS) and Constant Shoulder Score (CSS), along with low complication rates observed at 14 months. Bone block procedures demonstrated good to excellent outcomes without recurrent dislocations. Joint preservation procedures had high complication rates.

Conclusion: Managing neglected anterior shoulder dislocations is complex, necessitating customised surgical approaches to optimise outcomes and minimise complications. Despite a heterogeneous patient population with significant functional demands, bone block procedures and RSA emerged as effective treatments.

Level of evidence: 4