Return to play and recurrent instability rates in open versus arthroscopic anterior shoulder stabilisation in the contact and collision athlete: A systematic review.

Abstract

The purpose of this systematic review is to compare return-to-play and recurrence rates in collision and contact athletes who undergo open or arthroscopic Bankart repair. The literature search was performed based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, using PubMED, Cochrane Library and Embase in April 2025. Cohort studies comparing the open and arthroscopic Bankart repair for anterior shoulder instability in contact/collision athletes were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager Version 5.3. Six clinical trials with 319 athletes were included. There was a statistically significant difference in favour of open Bankart repair for recurrent instability (7.2% vs. 17.9%, I² = 0%, p = 0.008). There was no statistically significant difference in return to play (91.2% vs. 92.6%, I² = 0%, p = 0.88), or return at pre-injury level (44.1% vs. 33.3%, I² = 14%, p = 0.19). Among those undergoing open Bankart repair, the best-case and worst-case analysis revealed that the recurrence rate could be between 8% and 9% in those able to return to play. Among those undergoing arthroscopic Bankart repair, the best-case and worst-case analysis revealed that the recurrence rate could be between 23.8% and 31% in those able to return to play. Contact or collision athletes undergoing anterior shoulder stabilisation have lower rates of recurrent instability when with an open Bankart repair. However, similar return-to-play rates are seen with either approach. Level III.