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
. 2025 Feb 6;13(2):23259671251316893.
doi: 10.1177/23259671251316893. eCollection 2025 Feb.

Management of First-Time Anterior Shoulder Dislocation-A Systematic Review and Meta-analysis: Arthroscopy Association of Canada Position Statement

Hassaan Abdel Khalik  1 , Danielle Dagher  1 , Darius Luke Lameire  2 , Eva Gusnowski  3 , Michaela Kolpka  4 , Marie-Eve LeBel  5 , Bogdan A Matache  6 , R Kyle Martin  7 , Mark Sommerfeldt  8 , Ivan Wong  9 , Jarret Woodmass  10 , Moin Khan  1
Affiliations
Review

Management of First-Time Anterior Shoulder Dislocation-A Systematic Review and Meta-analysis: Arthroscopy Association of Canada Position Statement

Hassaan Abdel Khalik et al. Orthop J Sports Med. .

Abstract

Background: While surgical stabilization is typically recommended for patients with recurrent shoulder instability, the management of first-time shoulder dislocation (FTSD) presents a unique challenge for health care providers.

Purpose: To assess the efficacy of arthroscopic Bankart repair (ABR) compared with nonoperative management for FTSDs.

Study design: Review.

Methods: MEDLINE, EMBASE, and CENTRAL were searched from inception to December 26, 2023, for comparative studies assessing ABR versus nonoperative management of FTSDs. Outcomes of interest included rates of shoulder redislocation, cumulative shoulder instability (redislocation, subluxation, and/or subjective instability), subsequent shoulder stabilization surgery, return-to-sport rates, and patient-reported outcomes (Western Ontario Shoulder Instability [WOSI] score and Rowe score). Meta-analyses were performed on outcomes reported across a minimum of 3 comparative studies.

Results: Eleven comparative studies with 694 patients (695 shoulders) were included in the final analysis. Patient demographics were comparable across arthroscopic stabilization (367 shoulders) and nonoperative management (328 shoulders) groups with a mean age of 21.6 ± 2.5 years across all studies, and 13.7% ± 13.6% of patients being female. The mean follow-up across all studies was 54.2 ± 28.5 months, with a mean loss to follow-up of 8.1% ± 10.3%. Meta-analyses demonstrated a reduction in the odds of cumulative instability in favor of the ABR group (odds ratio [OR], 0.04 [95% CI, 0.02 to 0.08]; P < .01), as well as reductions in the odds of shoulder redislocation (OR, 0.06 [95% CI, 0.02 to 0.17]; P < .01) and subsequent stabilization surgery (OR, 0.07 [95% CI, 0.03 to 0.14]; P < .01) in favor of ABR. Compared with the nonoperative group, patients in the ABR group were 3.87 times more likely to return to sport at the preoperative or higher level (OR, 3.87 [95% CI, 1.57 to 9.52]; P < .01). No differences were found across postoperative WOSI scores (mean difference, 8.08 [95% CI, -1.54 to 17.69]; P = .10). Subgroup analyses demonstrated similar outcomes between randomized controlled trials and observational studies.

Conclusion: Early ABR of first-time anterior shoulder dislocations consistently demonstrated decreased subsequent rates of cumulative instability events, shoulder redislocations, and revision surgeries relative to nonoperative management.

Keywords: anterior shoulder dislocation; anterior shoulder instability; arthroscopic Bankart repair; shoulder stabilization surgery.

PubMed Disclaimer

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: J.G. has received research support from Arthrex, JRF Ortho, Vericel, and Aesculap Biologics; education payments from Arthrex; nonconsulting fees from Arthrex and ConMed; and consulting/nonconsulting fees from Vericel, JRF Ortho, and Tactile Orthopaedics. B.A.M. has received consulting fees from Arthrex. R.K.M. has received education payments from Arthrex and Smith & Nephew. M.P. has received consulting fees from Arthrex and ConMed. B.S. has received nonconsulting fees from ConMed and Smith & Nephew. M.S. has received consulting fees from Arthrex. I.W. has received consulting fees from DePuy Mitek, Smith & Nephew, and ConMed and nonconsulting fees from DePuy Mitek, Smith & Nephew, ConMed, and Bioventus. He is a paid associate editor for The Orthopaedic Journal of Sports Medicine. 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 Reviews and Meta-Analyses) diagram of the study inclusion process. FT, full text.
Figure 2.
Figure 2.
Risk-of-bias assessment for the included randomized controlled trials.,,,
Figure A1.
Figure A1.
Results of meta-analysis on cumulative instability.
Figure A2.
Figure A2.
Results of meta-analysis on redislocation rate.
Figure A3.
Figure A3.
Results of meta-analysis on subsequent stabilization surgery.
Figure A4.
Figure A4.
Results of meta-analysis on return to sport at the same or higher level.
See this image and copyright information in PMC

References

    1. Abdel Khalik H, Lameire DL, Leroux T, Bhandari M, Khan M. Arthroscopic stabilization surgery for first-time anterior shoulder dislocations: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2024;33(8):1858-1872. doi:10.1016/j.jse.2024.01.037 - DOI - PubMed
    1. Abrams R, Akbarnia H. Shoulder dislocations overview. In: StatPearls. StatPearls Publishing; 2024. Accessed March 4, 2024. http://www.ncbi.nlm.nih.gov/books/NBK459125 - PubMed
    1. Adam M, Attia AK, Alhammoud A, Aldahamsheh O, Al Ateeq Al, Dosari M, Ahmed G. Arthroscopic Bankart repair for the acute anterior shoulder dislocation: systematic review and meta-analysis. Int Orthop. 2018;42(10):2413-2422. doi:10.1007/s00264-018-4046-0 - DOI - PubMed
    1. Alkhatib N, Abdullah ASA, AlNouri M, Ahmad Alzobi OZ, Alkaramany E, Ishibashi Y. Short- and long-term outcomes in Bankart repair vs. conservative treatment for first-time anterior shoulder dislocation: a systematic review and meta-analysis of randomized controlled trials. J Shoulder Elbow Surg. 2022;31(8):1751-1762. doi:10.1016/j.jse.2022.02.032 - DOI - PubMed
    1. Arciero RA, Wheeler JH, Ryan JB, McBride JT. Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med. 1994;22(5):589-594. doi:10.1177/036354659402200504 - DOI - PubMed

LinkOut - more resources