Guideline Alignment

Current guidelines, such as those from the American Academy of Orthopaedic Surgeons (AAOS), typically recommend a period of non-operative treatment following a first-time shoulder dislocation, particularly in younger patients. This involves immobilization, followed by a structured rehabilitation program. Surgery is generally reserved for recurrent instability or specific patient factors, such as high-demand athletes or those with associated injuries like Bankart lesions. This approach aims to balance the risks of surgery with the potential for spontaneous stabilization and avoidance of long-term complications. The findings of this review, suggesting a potentially quicker return to sport with early surgery, do not necessarily contradict these guidelines but rather highlight an area where individualized decision-making, considering the athlete's specific needs and risk tolerance, is paramount. We should be asking ourselves if the traditional guidelines adequately address the unique demands and expectations of elite athletes.

Study Limitations

Scoping reviews, by their nature, synthesize a broad range of evidence, often including studies with varying methodologies and quality. This inherent heterogeneity makes it challenging to draw definitive conclusions or perform meta-analyses. A key limitation of the evidence base on early versus delayed surgery for shoulder dislocations is the lack of large, randomized controlled trials. Most studies are retrospective or prospective cohort studies with relatively small sample sizes, increasing the risk of bias and limiting the generalizability of findings. Another significant limitation is the variability in surgical techniques and rehabilitation protocols across studies. Without standardization, it is difficult to isolate the specific impact of early versus delayed surgery on outcomes such as return to sport and post-traumatic arthritis. Furthermore, the definition of "return to sport" varies, making it difficult to compare results across studies. Are we talking about returning to full pre-injury level, or simply participating in some form of athletic activity?

Surgical Techniques

The surgical approach to shoulder instability following dislocation has evolved significantly. Arthroscopic surgery, using techniques like Bankart repair (reattachment of the labrum to the glenoid), is now the predominant method. This minimally invasive approach offers several advantages, including smaller incisions, reduced pain, and potentially faster recovery compared to open surgery. However, open procedures like the Latarjet procedure (coracoid transfer) may still be considered in cases of significant bone loss or revision surgery. The choice of surgical technique depends on factors such as the extent of the labral tear, the presence of bone loss, and the surgeon's experience. Regardless of the chosen technique, meticulous surgical technique and adherence to established principles of shoulder stabilization are crucial for achieving optimal outcomes. The review needs to ask whether a specific surgical approach has proven superior.