Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill-Sachs and Bankart lesions: a systematic review and meta-analysis

Abstract

Purpose: The extent of shoulder instability and the indication for surgery may be determined by the prevalence or size of associated lesions. However, a varying prevalence is reported and the actual values are therefore unclear. In addition, it is unclear whether these lesions are present after the first dislocation and whether or not these lesions increase in size after recurrence. The aim of this systematic review was (1) to determine the prevalence of lesions associated with traumatic anterior shoulder dislocations, (2) to determine if the prevalence is higher following recurrent dislocations compared to first-time dislocations and (3) to determine if the prevalence is higher following complete dislocations compared to subluxations.

Methods: PubMed, EMBASE, Cochrane and Web of Science were searched. Studies examining shoulders after traumatic anterior dislocations during arthroscopy or with MRI/MRA or CT published after 1999 were included. A total of 22 studies (1920 shoulders) were included.

Results: The proportion of Hill-Sachs and Bankart lesions was higher in recurrent dislocations (85%; 66%) compared to first-time dislocations (71%; 59%) and this was statistically significant (P < 0.01; P = 0.05). No significant difference between recurrent and first-time dislocations was observed for SLAP lesions, rotator-cuff tears, bony Bankart lesions, HAGL lesions and ALPSA lesions. The proportion of Hill-Sachs lesions was significantly higher in complete dislocations (82%) compared to subluxations (54%; P < 0.01).

Conclusion: Higher proportions of Hill-Sachs and Bankart were observed in recurrent dislocations compared to first-time dislocations. No difference was observed for bony Bankart, HAGL, SLAP, rotator-cuff tear and ALPSA. Especially when a Hill-Sachs or Bankart is present after first-time dislocation, early surgical stabilization may need to be considered as other lesions may not be expected after recurrence and to limit lesion growth. However, results should be interpreted with caution due to substantial heterogeneity and large variance.

Level of evidence: IV.

Keywords: Epidemiology; Glenoid labrum; Hill–Sachs; Labrum lesions; Prevalence; Shoulder dislocation; Shoulder instability.

Fig. 1

PRISMA Flow diagram[60]

Fig. 2

Meta-analysis of Hill–Sachs first-time vs recurrent proportions. This meta-analysis shows the odds ratio for studies (n = 7) that reported the prevalence of Hill–Sachs lesions in first-time dislocations compared to recurrent dislocations

Fig. 3

Meta-analysis of Bankart first-time vs recurrent dislocation proportions. This meta-analysis shows the odds ratio for studies (n = 5) that reported the prevalence of Bankart lesions in first-time dislocations compared to recurrent dislocations

Fig. 4

Meta-analysis of SLAP first-time vs recurrent dislocation proportions. This meta-analysis shows the odds ratio for studies (n = 5) that report the prevalence of SLAP lesions in first-time dislocations compared to recurrent dislocations

Fig. 5

Meta-analysis of rotator-cuff tear first-time vs recurrent dislocation proportions. This meta-analysis shows the odds ratio for studies (n = 5) that report the prevalence of rotator-cuff tears in first-time dislocations compared to recurrent dislocations

Fig. 6

Meta-analysis of bony Bankart first-time vs recurrent dislocation proportions. This meta-analysis shows the odds ratio for studies (n = 4) that report the prevalence of bony Bankart lesions in first-time dislocations compared to recurrent dislocations

Fig. 7

Meta-analysis of HAGL first-time vs recurrent dislocation proportions. This meta-analysis shows the odds ratio for studies (n = 4) that report the prevalence of HAGL lesions in first-time dislocations compared to recurrent dislocations

Fig. 8

Proportions of ALPSA lesions for first-time dislocations compared to recurrent dislocations. This meta-analysis shows the odds ratio for studies (n = 3) that report the prevalence of ALPSA lesions in first-time dislocations compared to recurrent dislocations

Fig. 9

Meta-analysis of Hill–Sachs subluxation vs complete dislocation proportions. This meta-analysis shows the odds ratio for studies (n = 3) that report the prevalence of Hill–Sachs lesions in sub-dislocations compared to complete dislocations