This prospective observational study was performed on young patients, less than 24 years old, with first- time, traumatic anterior shoulder dislocations. These patients were offered either arthroscopic or nonopera tive treatment. Fifty-three patients chose nonoperative treatment. Sixty-three patients elected to have arthro scopic procedures. The average patient age was 19.6 years. There were 59 men and 4 women. All proce dures were performed within 10 days of dislocation. All 63 patients had hemarthrosis. Sixty-one of 63 (97%) patients treated surgically had complete detachment of the capsuloligamentous complex from the glenoid rim and neck (Perthes-Bankart lesion), with no gross evi dence of intracapsular injury. Of the other two patients, one had an avulsion of the inferior glenohumeral liga ment from the neck of the humerus, and one had an interstitial capsular tear adjacent to the intact glenoid labrum. Fifty-seven patients had Hill-Sachs lesions; none were large. There were six superior labral ante rior posterior lesions, two with detachment of the bi ceps tendon. There were no rotator cuff tears. Of the 53 nonoperatively treated patients, 48 (90%) have de veloped recurrent instability. In this population, the capsulolabral avulsion appeared to be the primary gross pathologic lesion after a first-time dislocation. These findings, associated with the 90% nonoperative recurrence rate, suggest a strong association between recurrent instability and the Perthes-Bankart lesion in this population.
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