***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Shoulder joint dislocations collected from a r and omized population were investigated in Sweden , wherein nearly 50 % of people with primary dislocations never visit hospitals nor are treated by a physician . Thus information obtained from surgically treated patients is of limited value because cases requiring operative repair represent only a small and selected percentage of the population . The incidence of  shoulder dislocation in people from 18 to 70 years of age was at least 1.7 % and was three times more common in males . Spontaneous healing of recurrent dislocations in a period of many years was not uncommon .  Shoulder joint dislocation was more common among children than was generally appreciated , with the prognosis usually good . Recurrences of primary dislocations in people 15 to 25 years of age were not as frequent as was expected BACKGROUND Anterior dislocation of the glenohumeral joint in younger patients is associated with a high risk of recurrence and persistent functional deficits . The aim of this study was to assess the efficacy of a primary arthroscopic Bankart repair , while controlling for the therapeutic effects produced by the arthroscopic intervention and joint lavage . METHODS In a single-center , double-blind clinical trial , eighty-eight adult patients under thirty-five years of age who had sustained a primary anterior glenohumeral dislocation were r and omized to receive either an arthroscopic examination and joint lavage alone or together with an anatomic repair of the Bankart lesion .  Assessment of the rate of recurrent instability , functional outcome ( with use of three scores ) , range of movement , patient satisfaction , direct health-service costs , and treatment complications was completed for eighty-four of these patients ( forty-two in each group ) during the subsequent two years . RESULTS In the two years after the primary dislocation , the risk of a further dislocation was reduced by 76 % and the risk of all recurrent instability was reduced by 82 % in the Bankart repair group compared with the group that had arthroscopy and lavage alone . The functional scores were also better ( p < 0.05 ) , the treatment costs were lower ( p = 0.012 ) , and patient satisfaction was higher ( p < 0.001 ) after arthroscopic repair . The improved functional outcome appeared to be mediated through the prevention of instability since the functional outcome in patients with stable shoulders was similar , irrespective of the initial treatment allocation . The patients who had a Bankart repair and played contact sports were also more likely to have returned to their sport at two years ( relative risk = 3.4 , p = 0.007 ) . CONCLUSIONS Following a first-time anterior dislocation of the shoulder , there is a marked treatment benefit from primary arthroscopic repair of a Bankart lesion , which is distinct from the so-called background therapeutic effect of the arthroscopic examination and lavage of the joint . However , primary repair does not appear to confer a functional benefit to patients with a stable shoulder at two years after the dislocation Background Nonoperative treatment of traumatic shoulder dislocations leads to a high rate of recurrent dislocations . Hypothesis Early arthroscopic treatment for shoulder dislocation will result in a lower recurrence rate than nonoperative treatment . Study Design Prospect i ve , r and omized clinical trial . Methods Two groups of patients were studied to compare nonoperative treatment with arthroscopic Bankart repair for acute , traumatic shoulder dislocations in young athletes . Fourteen nonoperatively treated patients underwent 4 weeks of immobilization followed by a supervised rehabilitation program . Ten operatively treated patients underwent arthroscopic Bankart repair with a bioabsorbable tack followed by the same rehabilitation protocol as the nonoperatively treated patients . The average follow-up was 36 months . Results Three patients were lost to follow-up . Twelve nonoperatively treated patients remained for follow-up . Nine of these ( 75 % ) developed recurrent instability . Six of the nine have required subsequent open Bankart repair for recurrent instability . Of the nine operatively treated patients available for follow-up , only one ( 11.1 % ) developed recurrent instability . Conclusions Arthroscopic stabilization of traumatic , first-time anterior shoulder dislocations is an effective and safe treatment that significantly reduces the recurrence rate of shoulder dislocations in young athletes when compared with conventional , nonoperative treatment BACKGROUND An initial anterior dislocation of the shoulder becomes recurrent in 66 % to 94 % of young patients after immobilization of the shoulder in internal rotation .  Magnetic resonance imaging and studies of cadavera have shown that coaptation of the Bankart lesion is better with the arm in external rotation than it is with the arm in internal rotation . Our aim was to determine the benefit of immobilization in external rotation in a r and omized controlled trial . METHODS One hundred and ninety-eight patients with an initial anterior dislocation of the shoulder were r and omly assigned to be treated with  immobilization in either internal rotation ( ninety-four shoulders ) or external rotation  ( 104 shoulders ) for three weeks . The primary outcome measure was a recurrent dislocation or subluxation . The minimum follow-up period was two years . RESULTS The follow-up rate was seventy-four ( 79 % ) of ninety-four in the internal rotation group and eighty-five ( 82 % ) of 104 in the external rotation group . The compliance rate was thirty-nine ( 53 % ) of seventy-four in the internal rotation group and sixty-one ( 72 % ) of eighty-five in the external rotation group ( p = 0.013 ) . The intention-to-treat analysis revealed that the recurrence rate in the external rotation group ( twenty-two of eighty-five ; 26 % ) was significantly lower than that in the internal rotation group ( thirty-one of seventy-four ; 42 % ) ( p = 0.033 ) with a relative risk reduction of 38.2 % . In the subgroup of patients who were thirty years of age or younger , the relative risk reduction was 46.1 % . CONCLUSIONS Immobilization in external rotation after an initial shoulder dislocation reduces the risk of recurrence compared with that associated with the conventional method of immobilization in internal rotation . This treatment method appears to be particularly beneficial for patients who are thirty years of age or younger Purpose The purpose of this study was to compare clinical outcomes between a  primary dislocation group ( group P ) and a recurrent dislocation group ( group R ) with combined lesion of Bankart and type II SLAP lesions ( type V SLAP lesion ) and to evaluate incidence of type V SLAP lesion . In addition , the authors evaluated clinical outcomes of these patients by dividing two groups according to the sequence for Bankart and SLAP lesion suture . Methods From May 2000 to May 2005 , 310 patients who gave informed consent , underwent the diagnostic arthroscopy and magnetic resonance arthrography ( MRA ) . One hundred and ten patients met the following criteria : ( 1 ) post-traumatic primary or recurrent anterior shoulder instability , ( 2 ) a normal contralateral shoulder , ( 3 ) a type V SLAP lesion , and ( 4 ) minimum follow-up of two years . Group P included 42 patients , and group R , 68 patients . Among all patients , 58 patients who had Bankart lesions sutured first were included in group B , and 52 who had their SLAP lesions sutured beforeh and , group S. Visual analogue scale , range of motion , Rowe and Constant score were used to compare results between group P and group R , also group B and group S. Results The incidence rates of type V SLAP lesion were 42.8 % in group P and 32.0 % in group R. The overall treatment results in our study were good . Even if the difference between the two groups was statistically insignificant , group P showed greater recovery of range of motion than group R in external rotation . No significant difference was found between the two different operative methods according to suture sequence . Conclusion The incidence rates of type V SLAP lesion were 42.8 % in the primary dislocation group and 32.0 % in the recurrent dislocation group . The overall treatment results in our study were good . Although there was no statistical significance in surgical time between the two groups , when both SLAP and Bankart lesions are present , the Bankart lesion must be sutured first to reduce surgical time Background : There is no consensus on the optimal treatment of in-season athletes with anterior shoulder instability , and limited data are available to guide return to play . Purpose : To examine the likelihood of return to sport and the recurrence of instability after an in-season anterior shoulder instability event based on the type of instability ( subluxation vs dislocation ) . Additionally , injury factors and patient-reported outcome scores administered at the time of injury were evaluated to assess the predictability of eventual successful return to sport and time to return to sport during the competitive season . Study Design : Cohort study ( prognosis ) ; Level of evidence , 2 . Methods : Over 2 academic years , 45 contact intercollegiate athletes were prospect ively enrolled in a multicenter observational study to assess return to play after in-season anterior glenohumeral instability . Baseline data collection included shoulder injury characteristics and shoulder-specific patient-reported outcome scores at the time of injury . All athletes underwent an accelerated rehabilitation program without shoulder immobilization and were followed during their competitive season to assess the success of return to play and recurrent instability . Results : Thirty-three of 45 ( 73 % ) athletes returned to sport for either all or part of the season after a median 5 days lost from competition ( interquartile range , 13 ) . Twelve athletes ( 27 % ) successfully completed the season without recurrence . Twenty-one athletes ( 64 % ) returned to in-season play and had subsequent recurrent instability including 11 recurrent dislocations and 10 recurrent subluxations . Of the 33 athletes returning to in-season sport after an instability event , 67 % ( 22/33 ) completed the season . Athletes with a subluxation were 5.3 times more likely ( odds ratio [ OR ] , 5.32 ; 95 % CI , 1.00 - 28.07 ; P = .049 ) to return to sport during the same season when compared with those with dislocations . Logistic regression analysis suggests that the Western Ontario Shoulder Instability Index ( OR , 1.05 ; 95 % CI , 1.00 - 1.09 ; P = .037 ) and Simple Shoulder Test ( OR , 1.03 ; 95 % CI , 1.00 - 1.05 ; P = .044 ) administered after the initial instability event are predictive of the ability to return to play . Time loss from sport after a shoulder instability event was most strongly and inversely correlated with the Simple Shoulder Test ( P = .007 ) at the time of initial injury . Conclusion : In the largest prospect i ve study evaluating shoulder instability in in-season contact athletes , 27 % of athletes returned to play and completed the season without subsequent instability . While the majority of athletes who return to sport complete the season , recurrent instability events are common regardless of whether the initial injury was a subluxation or dislocation BACKGROUND During 1978 and 1979 , we initiated a prospect i ve multicenter study to evaluate the results of nonoperative treatment of primary anterior shoulder dislocation . In the current report , we present the outcome after twenty-five years . METHODS Two hundred and fifty-five patients ( 257 shoulders ) with an age of twelve to forty years who had a primary anterior shoulder dislocation were managed with immobilization ( achieved by tying the arm to the torso with use of a b and age ) or without immobilization .  All 227 living patients ( 229 shoulders ) completed the follow-up question naire , and 214 patients completed the Disabilities of the Arm , Shoulder and H and ( DASH ) question naire . RESULTS Ninety-nine ( 43 % ) of 229 shoulders had not redislocated , and seventeen ( 7 % ) redislocated once . Thirty-three recurrent dislocations had become stable over time ( 14.4 % ) , and eighteen were considered to be still recurrent ( 7.9 % ) . Sixty-two shoulders ( 27 % ) had undergone surgery for the treatment of recurrent instability . Immobilization after the primary dislocation did not change the prognosis . Only two of twenty-four shoulders with a fracture of the greater tuberosity at the time of the primary dislocation redislocated ( p < 0.001 ) . When shoulders with a fracture of the greater tuberosity were excluded , forty-four ( 38 % ) of 115 shoulders in patients who had been twelve to twenty-five years of age at the time of the original dislocation and sixteen ( 18 % ) of ninety shoulders in patients who had been twenty-six to forty years of age had undergone surgical stabilization . At twenty-five years , fourteen ( 23 % ) of sixty-two shoulders that had undergone surgical stabilization were in patients who subsequently had a contralateral dislocation , compared with seven ( 7 % ) of ninety-nine shoulders in patients in whom the index dislocation had been classified as solitary ( p = 0.01 ) . Gender and athletic activity did not appear to affect the redislocation rate ; however , women had worse DASH scores than men did ( p = 0.006 ) . CONCLUSIONS After twenty-five years , half of the primary anterior shoulder dislocations that had been treated nonoperatively in patients with an age of twelve to twenty-five years had not recurred or had become stable over time Background : Conservative treatment of posttraumatic antero-inferior shoulder instability leads to a high failure rate in a young and active population . However , treatment in an adolescent age group is not well documented . Methods : We conducted a prospect i ve study with adolescent patients ( age 15 to 18 y ) who suffered a first traumatic anterior dislocation of the shoulder . Two groups of patients were formed . The first group was treated with early arthroscopic stabilization and the second was treated conservatively . There were 43 shoulders in the operative group and 29 shoulders in the conservative group . The rehabilitation protocol was the same for both groups . All patients were followed up prospect ively after 12 , 24 , and 36 months using Rowe Score . Results : A total of 38 shoulders 
    Output:
    
Conclusion The outcome of immediate arthroscopic repair of primary anterior shoulder dislocation is superior and encouraging with significant reduction in failure and revision rates compared to conservative treatment .
Nevertheless , the failure and revision rates are statistically insignificant compared to arthroscopic reconstruction of recurrent dislocation .
Hence , there is evidence to support immediate arthroscopic repair option for primary anterior shoulder dislocations over conservative treatment in young active patients , in order to reduce the risk of failure and revision rates .
However , the evidence is inconclusive compared to arthroscopic reconstruction of recurrent dislocation