present our research today. The relevant disclosures can be found on the Academy website. First-time anterior shoulder dislocation is often thought of in the provenance of the young. However, nearly 20% of all shoulder dislocations occur in patients over the age of 60. The incidence of first-time anterior shoulder dislocation in the age group 50 to 70 ranges anywhere in the literature from 12.9 to 28.1 per 100,000 person-years. First-time anterior shoulder dislocation has a different injury pattern, obviously, in older patients compared to younger. There's a decreased risk of recurrent shoulder dislocations. In the literature, it ranges anywhere from about 4% to 11%. However, because of increased age-related cuff tear degeneration, there's also an increased risk of associated rotator cuff tears. As we've been hearing over and over again in these sessions this morning, this is a really understudied area. Most of the studies that examine this topic were published before the turn of the century. Therefore, the purpose of this study was in patients over the age of 50 with first-time anterior shoulder dislocation to describe the incidence in epidemiology, the injury characteristics, the treatments and outcomes, and then the historical trends in diagnosis and treatment. We utilize the Rochester Epidemiology Project, which is a sample population, geographic sample of the U.S. population. It was done between 1994 to 2016. Patients were included if they were over the age of 50 at the time of initial instability event and if there was at least two years of clinical and radiographic follow-up. Patients were excluded if they had a previous instability event before the age of 50 or if the instability was either posterior or multi-directional. Overall, 179 patients with first-time anterior shoulder dislocation were identified. The mean age was 60. There was 55% women and the average follow-up was around 11 years. Eight patients previously had had surgery on the same shoulder. All of these patients had had a previous rotator cuff repair. In our study population, the incidence rate of first-time anterior shoulder dislocation was 28.8 per 100,000 person years. This was slightly increased compared to what we had seen previously in the literature. In terms of concomitant x-ray injury characteristics, about 50% of all of our patients had a Hill Sachs lesion and one-fifth presented with a bony Bankart lesion. In terms of concomitant MRI pathology seen, 62% presented with a full thickness rotator cuff tear. Of these patients, one-half presented with just an isolated supra tear and one-quarter presented with a supra and infra tear. Soft tissue Bankart lesions were seen in about 50% of these patients. Overall, 47 patients ultimately required surgical intervention. 27 patients required a rotator cuff repair. In an anterior labral repair, open reduction internal fixation of either the humeral head of the or the glenoid or a reverse or total shoulder arthroplasty were performed in eight different patients. A latter-day was done in just two cases. 27 patients or 15.1% of the entire cohort experienced recurrent instability. Again, this was increased from the literature, which was about 4 to 11%. There's an average of about three either dislocations or subluxations and an average of three years after the initial instability. There were no instances of recurrent instability after surgical intervention. 25 patients or 14% of the total cohort developed arthritis and this occurred at an average of 7.5 years after the initial instability event. Eight patients went on to require reverse or total shoulder arthroplasty. The one-year rate of obtaining an MRI has increased pretty dramatically from 10% in the years 1994 to 1999 all the way up to 42% in the years 2015 to 2016. Similarly, the one-year rate of surgical intervention has increased from 5.1% in the years 1994 to 1999 all the way up to 52% in the years 2015 to 2016. Overall, the limitations of this study are the retrospective nature. There is non-standardized diagnostic and treatment algorithms. These were based on provider preference. In addition, we didn't have objective data for strength or range of motion at final follow-up for these patients. And finally, we weren't able to capture recurrences that occurred outside of the geographic area. Overall, our conclusions were that the incidence of first-time anterior shoulder dislocation in patients over the age of 50 was 28.8 per 100,000 person-years, again slightly higher than we had seen previously in the literature. Full thickness rotator cuff tears were the most common concomitant pathology observed on MRI. The rate of recurrent instability for the entire cohort was 15% and the mean time to recurrent instability was three years. 25% of the patients ultimately progressed to surgical intervention and rotator cuff tears were the most common reason for surgery. There were no instances of recurrent instability after operative intervention. Thank you so much.

anterior shoulder dislocation

patients over 50

incidence rate

associated injuries

surgical intervention