Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Apr 6;3(3):e951-e966.
doi: 10.1016/j.asmr.2021.02.002. eCollection 2021 Jun.

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

Hassanin Alkaduhimi  1 , James W Connelly  2 , Derek F P van Deurzen  1 , Denise Eygendaal  3   4 , Michel P J van den Bekerom  1   4
Affiliations
Review

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

Hassanin Alkaduhimi et al. Arthrosc Sports Med Rehabil. .

Abstract

Purpose: To determine the definitions for recurrence used in the literature, assess the consensus in using these definitions, and determine the impact of these definitions on recurrence rates.

Methods: A literature search was performed in PubMed and EMBASE including studies from 2000 to 2020 reporting on recurrence rates after anterior arthroscopic shoulder instability surgery. Dislocation, apprehension, subluxation and recurrence rates were compared.

Results: Ninety-one studies were included. In 68% of the eligible studies, recurrence rates are not well defined. Thirty (33%) studies did not report on dislocations, 45 (49%) did not report on subluxations, and 58 (64%) did not report on apprehension. Seventeen different definitions for recurrence of instability, 4 definitions of dislocations, and 8 definitions of subluxation were used.

Conclusion: Recurrence rates are poorly specified and likely underreported in the literature, hampering comparison with results of other studies. This highlights the need for a consensus on definition of recurrence across shoulder instability studies. We recommend not using the definition recurrence of instability anymore. We endorse defining dislocations as a radiographically confirmed dislocation or a dislocation that is manually reduced, subluxations as the feeling of a dislocation that can be (spontaneously) reduced without the need for a radiographically confirmed dislocation, and a positive apprehension sign as fear of imminent dislocation when placing the arm in abduction and external rotation during physical examination. Reporting on the events resulting in a dislocation or subluxation aids in making an estimation of the severity of instability.

Level of evidence: Level IV, systematic review.

PubMed Disclaimer

Figures

Fig 1
Fig 1
Flow chart. From 2569 studies in PubMed and EMBASE 282 are full-text screened, from which 89 studies are included.
Fig 2
Fig 2
Recurrence percentage for each definition. This figure shows the percentage of recurrence for each definition of recurrence: on the X-axis we have the different definitions and on the Y-axis the percentage of patients who have suffered a recurrence. When no percentage is reported, it means that it has not been reported in any study.
Fig 3
Fig 3
Dislocation percentage for each definition. This figure shows the percentage of dislocations for each definition of recurrence: on the X-axis we have the different definitions and on the Y-axis the percentage of patients who have suffered a dislocation. When no percentage is reported, it means that it has not been reported in any study.
Fig 4
Fig 4
Subluxation percentage for each definition. This figure shows the percentage of subluxations for each definition of recurrence: on the X-axis we have the different definitions, and on the Y-axis the percentage of patients who have suffered a subluxation. When no percentage is reported, it means that it has not been reported in any study.
Fig 5
Fig 5
Apprehension percentage for each definition. This figure shows the percentage of apprehension for each definition of recurrence: on the X-axis we have the different definitions, and on the Y-axis the percentage of patients having a positive apprehension sign. When no percentage is reported, it means that it has not been reported in any study.
See this image and copyright information in PMC

References

    1. Coyner K.J., Arciero R.A. Shoulder instability: anterior, posterior, multidirectional, arthroscopic versus open, bone block procedures. Sport Med Arthrosc Rev. 2018;26:168–170. - PubMed
    1. Froda S. d.e., Bokshan S., Stern E., Sullivan K., Owens B.D. Arthroscopic Bankart repair for the management of anterior shoulder instability: indications and outcomes. Curr Rev Musculoskelet Med. 2017;10:442–451. - PMC - PubMed
    1. Bhatia S., Frank R.M., Ghodadra N.S., et al. The outcomes and surgical techniques of the Latarjet procedure. Arthroscopy. 2014;30:227–235. - PubMed
    1. Gerometta A., Rosso C., Klouche S., Hardy P. Arthroscopic Bankart shoulder stabilization in athletes: return to sports and functional outcomes. Knee Surgery, Sport Traumatol Arthrosc. 2016;24:1877–1883. - PubMed
    1. Randelli P., Ragone V., Carminati S., Cabitza P. Risk factors for recurrence after Bankart repair a systematic review. Knee Surg Sports Traumatol Arthrosc. 2012;20:2129–2138. - PubMed