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. 2024 Oct 23;7(2):101032.
doi: 10.1016/j.asmr.2024.101032. eCollection 2025 Apr.

Arthroscopic Repair for Posterior Shoulder Instability Is Associated With Favorable Outcomes and High Return to Sport or Work: A Systematic Review and Meta-Analysis

Antonio Cusano  1 , Alexander J Ment  1 , Kevin A Hao  2 , Jayson Saleet  3 , Patrick Nian  4 , Emily Curry  3 , Michael Groot  1 , David Novikov  3 , Hussein Abdul-Rassoul  5 , Robert L Parisien  6 , Brett D Owens  7 , Xinning Li  3
Affiliations

Arthroscopic Repair for Posterior Shoulder Instability Is Associated With Favorable Outcomes and High Return to Sport or Work: A Systematic Review and Meta-Analysis

Antonio Cusano et al. Arthrosc Sports Med Rehabil. .

Abstract

Purpose: To assess clinical outcomes of primary arthroscopic repair for unilateral posterior shoulder instability (PSI) in all patients, to evaluate clinical outcomes in athletes, and to compare clinical outcomes between contact and overhead athletes.

Methods: A systematic review was performed using PRISMA Guidelines. Included studies reported on primary arthroscopic treatment of PSI with at least 1 year of follow-up. Studies were excluded if they were not in English, included revisions/open procedures or anterior/multidirectional instability, had fewer than 10 patients or no full text available, or were biomechanical analyses/descriptions of surgical technique. Primary outcomes were rates of return to sport (RTS), return to preinjury level (RTPL), recurrent instability, and revision surgery. Outcomes were evaluated in all patients and all athletes, with further subdivision for contact and overhead.

Results: Of the 1,504 screened studies, 30 met inclusion criteria (1,649 shoulders). Mean age at surgery was 23.3 years (range: 12.4-65 years), and mean follow-up was 35.5 months (range: 12-140.4 months). There were 1,051 males and 196 females. RTS rates were 91.7% among all patients and 90.9% in all athletes, with no statistical difference between contact and overhead athletes (92.8% vs 88.1%; P = .176). RTPL rates were 78.7% among all patients and 75.6% in all athletes, with no statistical difference between contact and overhead athletes (90.8% vs 62.3%; P = .072). Recurrent instability rates were 7.0% among all patients and 8.0% in all athletes, with no statistical difference between contact and overhead athletes (7.3% vs 7.4%; P = .981). Revision rates were 3.7% among all patients and 3.3% in all athletes, with no statistical difference between contact and overhead athletes (6.8% vs. 0%; P = 1).

Conclusion: Primary arthroscopic treatment of PSI is associated with favorable outcomes and high return to sport and work rates. Recurrent instability and pain were the most common reasons for revision.

Level of evidence: Level IV, Systematic review and meta-analysis of Level II to IV studies.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: K.A.H. has received consulting fees from LinkBio Corp. B.D.O. has received research support from Arthrex, DePuy Mitek, and Musculoskeletal Transplant Foundation; consulting fees from ConMed Linvatec, DePuy Mitek, Miach, Musculoskeletal Transplant Foundation, and Vericel; royalties from ConMed Linvatec, Saunders/Mosby–Elsevier, Slack, and Springer; has stock/stock options in Vivorte; and is a paid associate editor for the American Journal of Sports Medicine. X.L. has received consulting fees from DePuy Synthes and FH Ortho; a gift from Wright Medical Technology; and IP royalties from FH Ortho. R.L.P. has received education support from Arthrex. All other authors (A.C., A.J.M., J.S., P.N., E.C., M.G., D.N., H.A-R.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Forest plot of return to sport rates of all athletes.
Fig. 2
Fig. 2
Forest plot of return to sport rates for all athletes, with subanalyses for contact versus overhead athletes.
Fig. 3
Fig. 3
Forest plot of return to preinjury levels forall athletes.
Fig. 4
Fig. 4
Forest plot of return to preinjury levels for all athletes, with subanalyses for contact versusoverhead athletes.
Fig. 5
Fig. 5
Forest plot of overall recurrence rates for the entire cohort (all population).
Fig. 6
Fig. 6
Forest plot of overall recurrence rates for all athletes, with subanlyses for contact versus overhead athletes.
Fig. 7
Fig. 7
Forest plot of revision rates for the entire cohort (all population).
Fig. 8
Fig. 8
Forest plot of revision rates for all athletes, with subanalyses for contact versus overhead athletes.
Fig. 9
Fig. 9
Risk of bias table depicting quality assessment of studies.
See this image and copyright information in PMC

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