Traumatic anterior shoulder dislocation What is required to define optimal treatment strategies?

Traumatic anterior shoulder, or glenohumeral, dislocations are painful and functional shoulder instability limits patients in performing activities of daily living, sports and work. Up to 60% of patients experience redislocation following a first-time dislocation. If a patient experiences redislocation, it can increase damage to the joint, which in turn is associated with a higher redislocation risk. Selecting optimal treatment for patients can be a challenging process. There are effective operative interventions available, but it is unclear which patients should receive which intervention and in which stage. Risk factors associated with redislocation or worse outcomes can identify which treatment is suitable for the patient. These factors can guide the shared-decision making process when specific risk factors can be managed with the intervention of interest. This thesis demonstrates that (1) there are many inconsistencies in selection and definitions of risk factors; (2) the predictive value of risk factors can differ in specific patient groups; (3) it is important to evaluate the reliability and accuracy of quantifiable risk factors; (4) 3D position of the bony structures relative to each other can be a potential risk factor for redislocation; (5) there is insufficient awareness for standardization, timing and reporting of patient-reported outcome measures and (6) healthcare providers and patients can reach a consensus on which items are considered important to evaluate in shoulder instability research. Finally, taking these conclusions into account, it discusses what is required to define optimal treatment strategies following traumatic anterior shoulder dislocation.