Prevalence and risk factors for the development of glenohumeral osteoarthritis following arthroscopic Bankart repair: a systematic review and meta-analysis of studies with minimum 5-years follow-up.

Abstract

Glenohumeral osteoarthritis (GHOA) is a significant long-term complication that can arise from shoulder instability and stabilization following arthroscopic Bankart repair. However, the evidence on its development and impact remains unclear. This study aims to conduct a systematic review and meta-analysis to evaluate the long-term prevalence of GHOA in patients postarthroscopic Bankart repair and its potential risk factors. A comprehensive search of 4 databases (PubMed, EMBASE, Scopus, and Cochrane Library) was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses checklist. Articles which involved patients who underwent primary arthroscopic Bankart repair and postoperative radiological outcomes at a minimum follow-up duration of 5 years were included. Quality of studies was assessed using the modified Coleman Methodology Score. Single-arm meta-analysis of proportions was conducted for the presence of (a) any GHOA change and (b) moderate-to-severe GHOA changes. Subgroup analysis based on follow-up duration (studies with '5-10 years' vs. '>10 years') was conducted to evaluate long-term GHOA rates at different time intervals while meta-regression analysis was conducted using existing risk factors established in the literature. Lastly, meta-regression analysis was also conducted between Constant Shoulder Score and GHOA rates to evaluate the clinical significance of GHOA. Twelve articles including 11 single-arm studies and 1 randomized controlled trial were included, with a mean modified Coleman Methodology Score of 65.2 ± 7.0. Total sample size was 631 patients at baseline and 538 shoulders at final follow-up. Meta-analysis of proportions showed that pooled rates for any GHOA change and moderate-to-severe GHOA change were 60% and 28% respectively, over a pooled mean follow-up duration of 10.7 years (range 5-18 years). Subgroup analysis based on follow-up duration did not demonstrate significant difference in GHOA rates. Meta-regression analysis did not demonstrate any significant association between GHOA and the established risk factors as well as Constant Shoulder Score. Current evidence shows a prevalence of 60% for any GHOA changes and 28% for moderate-to-severe GHOA changes following arthroscopic Bankart repair. However, GHOA is generally asymptomatic. No significant correlation was identified with established risk factors.