Recurrent anterior shoulder instability: a review of the Latarjet procedure and its postoperative rehabilitation

Two Cases of Anterior Shoulder Dislocation and Fracture Secondary to Generalized Tonic-Clonic Seizure

Dislocation of the glenohumeral joint secondary to generalized tonic-clonic seizures is well documented in the medical literature, with posterior dislocation being most commonly described. Still, these occurrences tend to be rare and affect a minority of patients, and fractures associated with dislocations after seizures are even less common. As such, the management of these injuries tends to be quite varied, and there is a paucity of documented cases in the literature. Here, we would like to present two rare cases of anterior shoulder dislocation secondary to seizures, with one patient also sustaining a fracture of the proximal humerus. We would also like to discuss the management and outcomes that have been achieved, since these cases tend to occur in a small number of epileptic patients.

Outcomes of the Latarjet procedure in female patients: A case series and matched-pair analysis

Background

The objective of this study was to retrospectively report on the outcomes of female patients undergoing the Latarjet procedure.

Methods

Female patients undergoing the Latarjet procedure with minimum 1 year follow-up were identified and contacted to obtain Numeric Pain Rating Scale (NPRS), Subjective Shoulder Value (SSV), and return to sport (RTS) data. Eligible females were then matched 1:1 with a male counterpart based on laterality and age (± 3 years), and outcomes compared.

Results

A total of 20 female patients with a mean follow-up of 73.8 months reported postoperative NPRS and SSV scores of 2.2  ±  2.3 and 69.3  ±  22.0, respectively. Of the nine athletes, 3 (33%) reported a successful RTS at a mean of 9 months. Four patients (20.0%) required reoperation at a mean of 27.1 months. The matched analysis demonstrated similar NPRS scores between male and female patients and a trend towards lower SSV scores and rates of RTS.

Conclusion

At mid-term follow-up female patients reported pain levels similar to female-specific literature reports, but overall low subjective shoulder function and RTS. Compared to propensity-matched males, females reported similar levels of pain, lower shoulder function, and lower rates of RTS, however, differences did not reach statistical significance.

Level of Evidence

IV, retrospective case series.

ASSESSMENT OF THE LEVEL OF SATISFACTION OF PATIENTS SUBMITTED TO LATARJET SURGERY UNDER OUTFIT SYSTEM COMPARED TO HOSPITAL SYSTEM

Anterior shoulder instability causes functional changes that affect patients' quality of life. The Latarjet procedure is one of the most frequently performed surgeries for cases of recurrent shoulder instability.

Objective

To assess the level of satisfaction of patients who underwent the Latarjet procedure in outpatient settings (day hospital) compared with inpatient settings.

Methods

A questionnaire was administered to both groups and a descriptive analysis of the results was performed.

Results

51 patients were included, with a mean age of 29.9 years, 82.3% men and 17.6% women. Of the patients who underwent surgery in the day hospital, 46.1% were operated within 100 days of their first outpatient visit; among those in the inpatient group, 76.3% underwent surgery more than 200 days later. Delays occurred in 15.3% of cases in the day hospital compared with 68.4% in the inpatient group. Of the patients in the day hospital, 92.3% felt comfortable contacting the medical team in case of complications and would perform the procedure again in the same setting. Moreover, 63.2% of inpatients would have preferred to have been discharged on the same day. The final satisfaction rate for both groups was 100%.

Conclusion

Outpatient surgery guarantees more patient comfort, safety, and can be performed in a timely manner and with fewer delays, which has influenced patients' decision to have surgery during the COVID-19 pandemic. Level of Evidence V, Cross-sectional Study.

Effect of Rehabilitation on Recurrent Shoulder Dislocation Post-Latarjet Procedure: A Case Report

Recurrent shoulder dislocation is often induced as a result of a traumatic situation that results in structural disease; however, a small subset of individuals suffer symptomatic recurrent shoulder instability without trauma. The glenohumeral articulation geometry offers a lot of flexibility at the sacrifice of inherent stability. The commonly dislocated joint is the shoulder joint as it has intrinsic instability that can lead to repeated dislocations. The procedure is designed to minimize the probability of problems. Physiotherapy is essential for regaining patients' mobility and enhancing their quality of life. A 36-year-old patient visited Acharya Vinoba Bhave Rural Hospital with complaints of pain graded 7/10 on the numerical pain rating scale and injury to the right shoulder joint after which there was repeated shoulder dislocation after a fall because of epilepsy five years back. The patient was diagnosed with recurrent shoulder dislocation which occurred approximately 50 times in a year as of January 24, 2022. The patient was managed with a Latarjet procedure on January 28, 2022. A well-planned physical therapy intervention significantly improved their overall status of health along with their ability to perform daily activities efficiently in post-operative patients with recurrent shoulder dislocation.

Arthroscopy with subscapularis upper one-third tenodesis for treatment of recurrent anterior shoulder instability independent of glenoid bone loss

BACKGROUND

Recurrent anterior shoulder instability is a common traumatic injury, the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head. The current follow-up study showed that the effect of arthroscopic Bankart repair is unreliable.

AIM

To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis for treatment of anterior shoulder instability, and to develop a method to further improve anterior stability and reduce the recurrence rate.

METHODS

Between January 2015 and December 2018, male patients with recurrent anterior shoulder instability were selected. One hundred and twenty patients had a glenoid defect < 20% and 80 patients had a glenoid defect > 20%. The average age was 25 years (range, 18–45 years). Patients with a glenoid defect < 20% underwent arthroscopic Bankart repair with a subscapularis upper one-third tenodesis. The patients with a glenoid defect > 20% underwent an arthroscopic iliac crest bone autograft with a subscapularis upper one-third tenodesis. All patients were assessed with Rowe and Constant scores.

RESULTS

The average shoulder forward flexion angle was 163.6° ± 8.3° and 171.8° ± 3.6° preoperatively and at the last follow-up evaluation, respectively. The average external rotation angle when abduction was 90° was 68.4° ± 13.6° and 88.5° ± 6.2° preoperatively and at the last follow-up evaluation, respectively. The mean Rowe scores preoperatively and at the last follow-up evaluation were 32.6 ± 3.2 and 95.2 ± 2.2, respectively (P < 0.05). The mean Constant scores preoperatively and at the last follow-up evaluation were 75.4 ± 3.5 and 95.8 ± 3.3, respectively (P < 0.05). No postoperative dislocations were recorded by the end of the follow-up period.

CONCLUSION

Arthroscopy with subscapularis upper one-third tenodesis was effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect, enhanced anterior stability of the shoulder, and did not affect postoperative range of motion of the affected limb.

Satisfactory Functional Results and Complication Rates After Anterior Glenoid Bone Block Reconstruction in Recurrent Shoulder Dislocation: A Mean 4-Year Follow-up Comparative Study

BACKGROUND

Anterior recurrent instability of the glenohumeral joint is a common clinical problem among the young population. Glenoid reconstruction with bone graft has become the treatment of choice, particularly in significant deficiency (˃ 20%). This study aims to assess the functional results of glenoid reconstruction using Latarjet and iliac bone graft in management of glenoid insufficiency associated with recurrent anterior dislocation of the glenohumeral joint.

METHODS

Patients suffering from anterior shoulder instability with glenoid defect > 20% were included in this study between 2016 and 2021. University of California at Los Angeles (UCLA) shoulder scale and Constant score were used to assess the functional improvement. Preoperative and final postoperative continuous outcomes were compared with one-tailed paired t-test and the outcomes across groups were compared using two-tailed independent t-test. P-value of < 0.05 was considered statistically significant for both tests.

RESULTS

This trial included 50 patients; twenty-five underwent mini-open Latarjet, and 25 underwent arthroscopic tricortical iliac bone grafting (ICBG). The mean follow-up durations were 50.1 ± 5.9 months for Laterjet and 51.6 ± 6.8 months for ICBG. Both techniques showed statistically significant improvement in the final UCLA (31.1± 2.1 in Laterjet, and 30.2± 2.2 in ICBG) and Constant (90.2± 4.6 in Laterjet, and 89± 5.01 in ICBG) scores. There was no statistically significant difference regarding mean age, sex, side of injury, mechanism of injury, follow-up period, and clinical outcome between both surgical treatments. At the end of the study, both groups demonstrated statistically significant improvement in the range of motion (p˂ 0.00001). Only one, non-adherent patient in Laterjet group had post-operative dislocation. In ICBG group, two patients had partial bone graft resorption, 3 graft site morbidities, and 1 hardware prominence.

CONCLUSION

Both Laterjet and iliac bone graft procedures had satisfactory functional results in reconstruction of glenoid defect > 20% in unstable shoulders with a mean 4-year follow-up. No statistically significant difference was reported in the last postoperative Constant and UCLA scores between both techniques, but Latarjet procedure had fewer complications (4%) than iliac bone grafting (24%).

LEVEL OF EVIDENCE

prospective non-randomized comparative study; level Ⅱ.

[Arthroscopic Pushlock anchor fixation with iliac creast bone autograft in the treatment of recurrent anterior shoulder instability with critical bone defect]

OBJECTIVE

To evaluate the effectiveness of arthroscopic Pushlock anchor fixation with iliac creast bone autograft in the treatment of recurrent anterior shoulder instability with critical bone defect.

METHODS

The clinical data of 80 patients with recurrent anterior shoulder instability with critical bone defect treated by arthroscopic Pushlock anchor fixation with iliac creast bone autograft between January 2016 and January 2019 were retrospectively analyzed. The patients were all male; they were 18-45 years old at the surgery, with an average of 25 years old. The disease duration ranged from 3 months to 5 years, with an average of 2 years. The shoulder joint dislocated 3-50 times, with an average of 8 times. X-ray films, MRI, CT scans and three-dimensional reconstruction of the shoulder were performed before operation. The area of the anterior glenoid defect was 25%-45%, with an average of 27.3%. The shoulder mobility (forward flexion and external rotation in abduction at 90°), the Constant-Murley score, and the Rowe score were used to evaluate the shoulder function before operation and at last follow-up.

RESULTS

Patients were followed up 1-3 years, with an average of 2 years. No shoulder dislocation occurred again during follow-up. All partial graft absorption occurred after operation, CT scan showed that the graft absorption ratio was less than 30% at 1 week and 3 months after operation. CT three-dimensional reconstruction at 1 year after operation showed that all grafts had healed to the glenoid. The anterior glenoid bone defect was less than 5% (from 0 to 5%, with an average of 3.2%). At last follow-up, the shoulder mobility (forward flexion and external rotation in abduction at 90°), the Constant-Murley score, and the Rowe score significantly improved when compared with preoperative ones ( P<0.05). The shoulder mobility of external rotation in abduction at 90° of the affected side limited when compared with the healthy side [(6.7±5.1)°].

CONCLUSION

Arthroscopic Pushlock anchor fixation with iliac creast bone autograft has a good effectiveness in the treatment of recurrent anterior shoulder instability with critical bone defect. The method is relatively simple and the learning curve is short.

A Comparison of Physical Therapy Protocols Between Open Latarjet Coracoid Transfer and Arthroscopic Bankart Repair

CONTEXT

Recent studies examining return to sport after traumatic shoulder instability suggest faster return-to-sport time lines after bony stabilization when compared with soft tissue stabilization. The purpose of the current study was to define variability across online Latarjet rehabilitation protocols and to compare Latarjet with Bankart repair rehabilitation time lines.

EVIDENCE ACQUISITION

Online searches were utilized to identify publicly available rehabilitation protocols from Accreditation Council for Graduate Medical Education (ACGME)-accredited academic orthopaedic surgery programs.

STUDY DESIGN

Descriptive epidemiology study.

LEVEL OF EVIDENCE

Level 3.

RESULTS

Of the 183 ACGME-accredited orthopaedic programs reviewed, 14 institutions (7.65%) had publicly available rehabilitation protocols. A web-based search yielded 17 additional protocols from private sports medicine practices. Of the 31 protocols included, 31 (100%) recommended postoperative sling use and 26 (84%) recommended elbow, wrist, and hand range of motion exercises. Full passive forward flexion goals averaged 3.22 ± 2.38 weeks postoperatively, active range of motion began on average at 5.22 ± 1.28 weeks, and normal scapulothoracic motion by 9.26 ± 4.8 weeks postoperatively. Twenty (65%) protocols provided specific recommendations for return to nonoverhead sport-specific activities, beginning at an average of 17 ± 2.8 weeks postoperatively. This was compared with overhead sports or throwing activities, for which 18 (58%) of protocols recommended beginning at a similar average of 17.1 ± 3.3 weeks.

CONCLUSION

Similar to Bankart repair protocols, Latarjet rehabilitation protocols contain a high degree of variability with regard to exercises and motion goal recommendations. However, many milestones and start dates occur earlier in Latarjet protocols when compared with Bankart-specific protocols. Consequently, variability in the timing of rehabilitation goals may contribute to earlier return to play metrics identified in the broader literature for the Latarjet procedure when compared with arthroscopic Bankart repair.

STRENGTH OF RECOMMENDATION TAXONOMY (SORT)

Level C.

Immediate self-rehabilitation after open Latarjet procedures enables recovery of preoperative shoulder mobility at 3 months

PURPOSE

To evaluate short-term clinical outcomes of shoulders treated for anterior instability by open Latarjet procedures (OLP) followed by immediate self-rehabilitation. The hypothesis was that patients would recover preoperative function at 3 months with no adverse events related to self-rehabilitation.

METHODS

The authors retrieved clinical and radiographic records of 307 consecutive shoulders treated by the same surgeon for anterior instability by OLP with immediate self-rehabilitation. Four shoulders did not meet eligibility criteria and 38 were lost to follow-up, leaving a study cohort of 265 shoulders. Patients performed self-rehabilitation exercises at home from the first postoperative day. Follow-ups at 1 and 3 months evaluated recurrence of instability, postoperative complications, pain, active forward elevation (AFE), passive forward elevation (PFE), external rotation (ER) and internal rotation (IR).

RESULTS

The difference between mobility before surgery and at 3 months was 0° for AFE, 0° for PFE, 10° for ER, and 0 spine segments for IR. Thirteen shoulders (5%) which had not followed the self-rehabilitation protocol during the first month had significantly more pain and less improvements in mobility (p < 0.05). Multivariable analyses revealed that patients who adhered to self-rehabilitation in the first month had greater improvements of AFE, PFE, and IR (p < 0.05).

CONCLUSIONS

Immediate self-rehabilitation after open Latarjet procedures enabled recovery of preoperative shoulder mobility at 3 months. Patients who did not adhere to immediate self-rehabilitation had more pain and less improvement in mobility. Furthermore, immediate self-rehabilitation was found to be independently associated with better recovery and did not cause any adverse events.

LEVEL OF EVIDENCE

Level IV.

Corpus callosotomy might have reduced epileptic seizure-induced repetitive shoulder joint dislocation in two patients with medically intractable epilepsy who were not focus resection candidates

Purpose

Treatment options appear lacking for patients with epileptic seizure-induced shoulder dislocations who are not candidates for shoulder and focus resection surgeries. To reduce shoulder joint dislocations caused by epileptic seizures and simultaneously reduce the frequency and intensity of seizures, we performed corpus callosotomy for two patients with medically intractable epilepsy that induced repetitive shoulder joint dislocations.

Materials and methods

A 21-year-old man (Patient 1) with bilateral temporal lobe epilepsy [Focal onset impaired awareness seizure (FIAS), 1/month; focal to bilateral tonic-clonic seizure (BTCS), 1/2–3 months], autism and intellectual disorder and a 34-year-old man (Patient 2) with left multi-lobar epilepsy (BTCS, 3–4/month; status epilepticus, 1/2–3 months), autism and intellectual disorder had suffered from repetitive seizure-induced shoulder dislocations (1/2–3 months for Patient 1; 3–4/month for Patient 2). Due to frequent seizures and uncooperativeness, they were not candidates for shoulder joint dislocation surgery. They were also not candidates for focus resection surgery due to multiple foci and uncooperativeness for invasive monitoring. We performed corpus callosotomy for both patients.

Results

Postoperatively, frequencies of both shoulder dislocations (2 in 5 years of follow-up for Patient 1; 1 in 5 months of follow-up for Patient 2) and epileptic seizures were drastically reduced.

Conclusions

For patients who are not candidates for focus resection and shoulder joint surgeries but who suffer from frequent shoulder joint dislocations, corpus callosotomy could be a treatment of last resort.

Eight-Week Return to Play Following Latarjet Shoulder Reconstruction in an Australian Football Player: A Case Report

Introduction: Anterior shoulder dislocation is a common injury in many sports, resulting in extended time lost from play with an extremely high recurrence rate in young athletes playing a high-risk sport. Latarjet shoulder reconstruction is a common surgical procedure used to prevent subsequent dislocation with an expected rehabilitation time frame of between 4 and 6 months before return to play. Case Description: A 21-year-old male Australian football player experienced 2 left-sided shoulder dislocations before undergoing a left Latarjet shoulder reconstruction. He was assessed clinically and with magnetic resonance imaging, which revealed significant tearing of the anterior labrum. The authors theorized that maximal glenohumeral stability occurs after bony healing of the coracoid onto the glenoid at 6 weeks. The patient then underwent an 8-week structured and graduated rehabilitation program aimed at preventing loss of shoulder range of motion, muscle, and functional capacity and returned to play at 8 weeks postinjury with no complications or recurrence at 12-month follow-up. Discussion: This is the first time an 8-week rehabilitation following Latarjet shoulder reconstruction has been reported. In athletes with anterior glenohumeral dislocation who require accelerated return to play, a Latarjet reconstruction with an 8-week rehabilitation protocol may be considered.

Outcomes of the Latarjet Procedure Compared With Bankart Repair for Recurrent Traumatic Anterior Shoulder Instability

Reference/Citation:  An VV, Sivakumar BS, Phan K, Trantalis J. A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair. J Shoulder Elbow Surg. 2016;25(5):853-863.

CLINICAL QUESTION

  Are clinical and patient-reported outcomes different between the Latarjet and Bankart repair stabilization procedures when performed for recurrent traumatic anterior shoulder instability?

DATA SOURCES

  Ovid MEDLINE, PubMed, Cochrane databases, American College of Physicians Journal Club, and Database of Abstracts of Review of Effectiveness were searched up to June 2015. The search terms used were Bankart AND Latarjet OR Bristow.

STUDY SELECTION

  Criteria used to include studies that (1) were written in English; (2) compared the outcomes of any Latarjet procedure (Bristow-Latarjet, coracoid transfer, or modified Bristow) with Bankart repair (anatomic); (3) reported a minimum of 1 outcome of recurrence, redislocation, revision, or patient-reported outcome measure; and (4) reported original data.

DATA EXTRACTION

  Data presented in any format (text, table, figure) were extracted from all included studies. The quality of each study was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Summary statistics were reported as relative risks and weighted mean differences. Fixed-effects (the assumed treatment effect was the same across studies) and random-effects (variations in treatment effect were assumed among studies) models were tested. Heterogeneity between trials was assessed using the χ² statistic, and the amount (percentage) of variation across studies due to heterogeneity was calculated using the I ² statistic. Forest plots were used to present pooled results.

MAIN RESULTS

  After the initial search, 245 articles were identified. After we applied the inclusion criteria, a total of 8 studies reporting on 795 patients (Latarjet = 379, Bankart = 416) were included in this review. Using the National Health and Medical Research Council's level of evidence, the authors scored 7 of the studies at level III and 1 study at level II. All Latarjet procedures were performed using an open technique, whereas the Bankart procedure was performed open in 6 studies and arthroscopically in 2 studies. The demographics of the patients (age, proportion of males to females, proportion with surgery on the dominant side, and proportion of revisions) were similar between the 2 surgical procedures. Four groups reported that patients who underwent the Latarjet procedure had fewer recurrences than patients in the Bankart repair group (11.6% versus 21.1%, respectively), irrespective of whether the Bankart was performed open or arthroscopically. Similarly, 4 groups observed that the Latarjet procedure resulted in fewer postsurgical redislocations (5.0%) than the Bankart (9.5%) procedure, irrespective of whether the repair was open or arthroscopic. The authors of 7 studies noted no differences between the 2 procedures in revision rates (Latarjet: 3.4%, Bankart: 4.5%), and 8 studies demonstrated no differences in complications requiring reoperation (Latarjet: 5.0%, Bankart: 3.1%). Investigators in 7 studies used the Rowe score to measure patient-reported satisfaction and function; patients who underwent the Latarjet procedure reported better Rowe scores postsurgically than patients who underwent the Bankart repair (scores: 79.0 and 85.4, respectively). Researchers in 4 studies reported a loss of external-rotation range of motion, which was less in the Latarjet (11.5°) compared with the Bankart (20.9°) procedure. Of the 5 groups that reported return to function, a trend suggested that a greater proportion of patients who underwent the Latarjet procedure returned to work, sport, and throwing activities compared with those who underwent the Bankart repair.

CONCLUSIONS

  The Latarjet procedure produced fewer recurrences, better patient-reported outcomes, and less restricted external-rotation motion than the Bankart repair.

Comparison of Magnetic Resonance Imaging and Computed Tomography Scans of the Glenoid Version in Anterior Dislocation of the Shoulder

The glenoid version is an important factor in the etiology of anterior dislocation of the shoulder and the planning of shoulder surgery. Few reports compare the magnetic resonance imaging (MRI) measurements of the glenoid version with those of computed tomography (CT). This study aimed to show that it is possible to use MRI instead of CT, which is accepted as the gold standard today for the evaluation of the glenoid version. A total of 55 patients with a history of 1 nonsurgically treated unilateral anterior dislocation of the shoulder who had both MRI and CT records for the dislocated shoulders constituted the study group. The glenoid version was measured in the axial plane on MRI and CT. Mean glenoid version measured by the observers was -1.6°±4.7° (95% confidence interval, -2.3° to -0.8°) and -1.8°±4.3° (95% confidence interval, -2.5° to -1.2°) by CT and MRI, respectively (P=.126). The evaluation of the CT and MRI measurements made by the 3 observers (X, Y, and Z) revealed no significant difference, as the P values of X CT - X MRI, Y CT - Y MRI, and Z CT - Z MRI were .550, .406, and .238, respectively. Interclass correlation among the 3 observers for CT and MRI was 0.996 and 0.981, respectively. The imaging methods of MRI and CT can be interchangeably used in the evaluation of the glenoid version in cases of anterior dislocation of the shoulder. [Orthopedics. 2017; 40(4):e687-e692.].

MORPHOLOGICAL ANALYSIS OF THE SCAPULA AND ITS IMPLICATIONS IN BRISTOW-LATARJET PROCEDURE

Objective:

To assess which of two procedures, Bristow or Latarjet, is anatomically the most appropriate for the general population.

Methods:

One thousand one hundred and thirty two shoulders were evaluated by an observer who measured the following coracoid process parameters - length, angle and minimum thickness - through Computed Tomography (CT) analysis. Statistical analysis was carried out by ANOVA and Bland-Altman tests.

Results:

The mean length, angle and minimum thickness of the coracoid were 27.0 ± 3.80 mm; 103.54 ± 14.03°; and 9.16 ± 6.38 mm, respectively. Gender differences were statistically significant.

Conclusion:

According to this image-based anatomic study, the coracoid process dimensions do not influence the choice between Bristow or Latarjet procedures. Level of Evidence III, Therapeutic Studies - Investigating the Results of Treatment.

The importance of glenoid version in patients with anterior dislocation of the shoulder

BACKGROUND

Although increased retroversion of the glenoid has been shown to be an important factor in posterior instability of the shoulder, there are few studies reporting glenoid bone structure as a risk factor in anterior dislocation of the shoulder. This study aimed to compare glenoid version in patients with anterior dislocation of the shoulder and individuals in a control group with no shoulder problems before undergoing computed tomography and to assess a possible relationship between demographic characteristics and glenoid version angle.

METHODS

The study group comprised 63 patients (12 women and 51 men; mean age, 35.71 years) with 1 or multiple unilateral anterior dislocations of the shoulder (dislocated group), whereas 63 individuals (11 women and 52 men; mean age, 35.38 years) with no history of shoulder complaints and no signs of instability constituted the control group. The glenoid version angle was measured on an axial cut of the computed tomography scan.

RESULTS

The glenoid version angles on the dislocated side in the study group were significantly more anteverted than those of the dominant (P < .001) and nondominant (P = .023) shoulders of the control group. The version angles of dislocated shoulders significantly differed from those of nondislocated shoulders of both men (P = .041) and women (P = .049). There was no significant relationship between the glenoid version angle on the dislocated side and dislocation mechanism (P = .883), age group (P = .356), or number of dislocations (P = .971).

CONCLUSIONS

Glenoid version is an important factor for the development of anterior dislocation of the shoulder.