To The Editor:
We read with interest the article "Can the Need for Future Surgery for Acute Traumatic Anterior Shoulder Dislocation Be Predicted?" (2007;89:1665-74), by Sachs et al. We believe that the counseling and information given to patients with regard to the potential benefits and risks of surgery can influence their choice between operative and nonoperative treatment. Were all of the patients included in this study given standardized counseling with regard to the role of surgical intervention? If so, what was the information given to them?
As the authors rightly point out, sports participation and overhead activities may influence the development of clinical instability and the risk of redislocation. Patients may modify their activities following a shoulder dislocation, which would in turn influence the risk of subsequent symptomatic instability. Thus, simply having a stable shoulder may not imply a fully satisfactory outcome if this required a lifestyle change. Did the patients who reported a stable shoulder change their lifestyle, and, if so, were they troubled by such a change?
We feel that following an initial traumatic dislocation, a thorough discussion must be made with patients as to their expectations and long-term aim in sports participation and overhead activities. The patients who wish to continue with sports activities should be counseled as to the success rate, recovery process, and risks associated with surgery, as part of making an informed treatment decision.