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Review
. 2018 Nov 16;6(11):2325967118805983.
doi: 10.1177/2325967118805983. eCollection 2018 Nov.

Anterior Shoulder Instability: A Systematic Review of the Quality and Quantity of the Current Literature for Surgical Treatment

Haley Glazebrook  1 , Blair Miller  2 , Ivan Wong  2
Affiliations
Review

Anterior Shoulder Instability: A Systematic Review of the Quality and Quantity of the Current Literature for Surgical Treatment

Haley Glazebrook et al. Orthop J Sports Med. .

Abstract

Background: Anterior shoulder instability is the most common sequela of shoulder dislocation and can result in repeated dislocations or subluxation of the glenohumeral joint. Anterior shoulder instability can be treated conservatively or surgically with several procedures.

Purpose: To date, arthroscopic Bankart is the most common surgical procedure for the treatment of anterior shoulder instability. No previous studies have compared all anterior shoulder surgical procedures. In this study, the authors performed a systematic review of journal articles describing all surgical procedures for anterior shoulder instability to determine the scientific evidence and level of recommendation.

Study design: Systematic review; Level of evidence, 4.

Method: A comprehensive literature search was conducted (July 19, 2016) with 4 reputed databases: PubMed, EMBASE, the Cochrane databases, and Web of Science. The articles found in the literature search were screened by 2 reviewers on the basis of their titles, abstracts, and full text. Data were extracted from relevant studies, and potentially relevant records were selected for full-text review. Included articles were classified according to their scientific quality (level of evidence, 1-5). The studies were then combined for each surgical procedure, and a grade of recommendation was assigned for each procedure: grade A, treatment recommendation based on level 1 evidence studies; B, based on level 2 or 3 evidence studies; C, based on level 4 or 5 evidence and could represent conflicting results; or I, insufficient evidence to recommend a treatment. As such, the grade of recommendation provides a summary score for the quality and quantity of available literature to support the surgical procedures reviewed here.

Results: The systematic literature review generated 11,281 articles. After screening, 655 articles were included. Results revealed 31 surgical procedures for shoulder instability following dislocation: 10 surgical procedures were given an A or B recommendation; 11, a C recommendation; and 10, an I recommendation.

Conclusion: This review identified many surgical procedures to treat anterior shoulder instability. Ten of these surgical procedures had an abundant amount of published articles to describe their safety and efficacy. Arthroscopic Bankart and open Bankart were the most commonly reported procedures that cite satisfactory postoperative outcomes and limited complications. Publications on the other surgical procedures were less common. Surgeons should be careful when recommending surgery, and they should choose the appropriate surgical procedure based on evidence-based literature.

Keywords: dislocation; glenohumeral; instability; shoulder; surgery.

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Conflict of interest statement

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) flow diagram: the search process for published literature from the online databases that met the inclusion criteria for this study.
See this image and copyright information in PMC

References

    1. Abdelhady A, Abouelsoud M, Eid M. Latarjet procedure in patients with multiple recurrent anterior shoulder dislocation and generalized ligamentous laxity. Eur J Orthop Surg Traumatol. 2015;25(4):705–708. - PubMed
    1. Ahmadain AM. The Magnuson-Stack operation for recurrent anterior dislocation of the shoulder: a review of 38 cases. J Bone Joint Surg Br. 1987;69(1):111–114. - PubMed
    1. Allain J, Goutallier D, Glorion C. Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am. 1998;80(6):841–852. - PubMed
    1. Altchek DW. Arthroscopic shoulder stabilization using a bioabsorbable fixation device. Instr Course Lect. 1996;45:91–96. - PubMed
    1. Amako M, Imai T, Okamura K. Recovery of shoulder rotational muscle strength after a combined Bankart and modified Bristow procedure. J Shoulder Elbow Surg. 2008;17(5):738–743. - PubMed