Surgical Treatment Is Superior to Conservative Options in Preventing Recurrence of First-Time Anterior Shoulder Dislocation in Adolescents and Adults Under 40 Years of Age: A Systematic Review and Network Meta-analysis.

Abstract

To compare the effectiveness of multiple treatments for first-time anterior shoulder dislocation in adolescents and young adults under 40 years of age. A systematic review and network meta-analysis of randomized controlled trials were conducted to compare 5 treatments for first-time anterior shoulder dislocation: arthroscopic Bankart repair, open Bankart repair, arthroscopic lavage, internal rotation immobilization, and external rotation immobilization. The primary outcome was recurrent instability, with secondary outcomes including functional scores, return to normal activities and sports, and patient satisfaction. A total of 10 randomized controlled trials were identified in the review, of which 8 involving 439 participants (mean age range: 20.0-25.3 years; maximum age 39 years) were included in the network meta-analysis. Surgical treatments, especially arthroscopic Bankart repair, exhibited lower recurrence risk, significantly outperforming external rotation immobilization (risk ratio [RR] = 0.15; 95% confidence interval [CI], 0.03-0.73) and internal rotation immobilization (RR = 0.14; 95% CI, 0.04-0.40). Arthroscopic Bankart repair showed no statistically significant difference in risk of recurrent instability when compared to open Bankart repair (RR = 4.19; 95% CI, 0.32-212.92) or when compared to arthroscopic lavage (RR = 0.3; 95% CI, 0.07-1.15). Both external rotation and internal rotation immobilization had the poorest outcomes, with no significant difference between them (RR = 0.91; 95% CI, 0.28-2.96). Surgical treatments were also associated with better functional outcomes, higher patient satisfaction, and higher rates of return to normal activities and sports. Surgical treatments are more effective than conservative options in preventing recurrent instability in adolescents and young adults under 40 years of age with first-time anterior shoulder dislocation. Arthroscopic Bankart repair has comparable efficacy in preventing the recurrence of open Bankart repair. Both external rotation and internal rotation immobilization had the poorest outcomes in terms of reducing recurrence instability rates, with no significant difference between them. Level I, systematic review and network meta-analysis of Level I studies.