Neer Award 2008: Arthropathy after primary anterior shoulder dislocation-223 shoulders prospectively followed up for twenty-five years

Background: Shoulder dislocation may cause arthropathy, but the natural history of this evolution is not well described. We therefore conducted a radiographic follow-up 25 years after the primary shoulder dislocation. Methods: A prospective Swedish Multicenter Study (1978-1979) included 257 shoulders in 255 patients (age, 12-40 years) with a first-time anterior shoulder dislocation. After 25 years, 227 patients (229 shoulders) were alive and had follow-up. Radiographic imaging was performed in 223 shoulders (97%). Results: Shoulders were normal in 44%. Arthropathy was mild in 29%, moderate in 9%, and severe in 17%. Of the shoulders without a recurrence, 18% had moderate/severe arthropathy. The corresponding figures were 39% for shoulders that recurred once or more (without surgery) and 26% (16 of 62) for surgically stabilized shoulders. Seven of 221 patients (7 of 223 shoulders) were considered alcoholic at 25 years and all had severe arthropathy (P < .001). Other factors that correlated with moderate/severe arthropathy were age older than 25 years at primary dislocation (P = .01) and primary dislocation caused by high-energy sports activity (P = .009). Shoulders that had not recurred had less arthropathy than shoulders classified as recurrent (P = .047) or stabilized over time (P = .007). Sixty-two surgically stabilized shoulders had less arthropathy than those that became stable over time (P = .047). Mild arthropathy at 10 years was associated with moderate/severe arthropathy at 25 years in 19 of 30 shoulders (63%) compared with 13 of 146 (9%) classified as normal at 10 years (P < .001). Joint incongruence at 10 years was associated with moderate/severe arthropathy at 25 years (P = .001). Conclusion: Age at primary dislocation, recurrence, high-energy sports, and alcohol abuse were factors associated with the development of arthropathy. Also shoulders without a recurrence were associated with arthropathy. Level of evidence: Level 1; Randomized controlled trial, therapeutic study. (C) 2009 Journal of Shoulder and Elbow Surgery Board of Trustees.