Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation

摘要

Objective To develop a multivariate tool that would predict recurrent instability after a first-time traumatic anterior shoulder dislocation.Methods Participants (aged 16–40 years) were recruited across New Zealand into a prospective cohort study. Baseline data were collected during a telephone interview and through examination of radiology records. Variables associated with recurrent instability were selected for the multivariate logistic regression model using backwards selection (p0.10). Coefficients for those variables retained in the model were used to develop the predictive tool.Results Among the 128 participants, 36% had redislocated at least once in the first 12 months. Univariate analysis showed an increased likelihood of recurrent dislocation with bony Bankart lesions (OR=3.65, 95%?CI 1.05 to 12.70, p=0.04) and participants who had: not been immobilised in a sling (OR = 0.38, 95%?CI 0.15 to 0.98, p=0.05), higher levels of shoulder activity (OR=1.13, 95%?CI 1.01 to 1.27, p=0.03), higher levels of pain and disability (OR=1.03, 95%?CI 1.01 to 1.06, p=0.02), higher levels of fear of reinjury (OR=1.12, 95%?CI 1.01 to 1.26, p=0.04) and decreased quality of life (OR=1.01, 95%?CI 1.00 to 1.02, p=0.05). There was no significant difference in those with non-dominant compared with dominant shoulder dislocations (p=0.10) or in those aged 16–25 years compared with 26–40 years (p=0.07).Conclusion Six of seven physical and psychosocial factors can be used to predict recurrent shoulder instability following a first-time traumatic anterior shoulder dislocation.