Anterior Shoulder Instability: A Systematic Review of the Quality and Quantity of the Current Literature for Surgical Treatment

Abstract

Background:Anterior shoulder instability is the most common sequela of shoulder dislocation and can result in repeated dislocations or subluxation of the glenohumeral joint. Anterior shoulder instability can be treated conservatively or surgically with several procedures.Purpose:To date, arthroscopic Bankart is the most common surgical procedure for the treatment of anterior shoulder instability. No previous studies have compared all anterior shoulder surgical procedures. In this study, the authors performed a systematic review of journal articles describing all surgical procedures for anterior shoulder instability to determine the scientific evidence and level of recommendation.Study Design:Systematic review; Level of evidence, 4.Method:A comprehensive literature search was conducted (July 19, 2016) with 4 reputed databases: PubMed, EMBASE, the Cochrane databases, and Web of Science. The articles found in the literature search were screened by 2 reviewers on the basis of their titles, abstracts, and full text. Data were extracted from relevant studies, and potentially relevant records were selected for full-text review. Included articles were classified according to their scientific quality (level of evidence, 1-5). The studies were then combined for each surgical procedure, and a grade of recommendation was assigned for each procedure: grade A, treatment recommendation based on level 1 evidence studies; B, based on level 2 or 3 evidence studies; C, based on level 4 or 5 evidence and could represent conflicting results; or I, insufficient evidence to recommend a treatment. As such, the grade of recommendation provides a summary score for the quality and quantity of available literature to support the surgical procedures reviewed here.Results:The systematic literature review generated 11,281 articles. After screening, 655 articles were included. Results revealed 31 surgical procedures for shoulder instability following dislocation: 10 surgical procedures were given an A or B recommendation; 11, a C recommendation; and 10, an I recommendation.Conclusion:This review identified many surgical procedures to treat anterior shoulder instability. Ten of these surgical procedures had an abundant amount of published articles to describe their safety and efficacy. Arthroscopic Bankart and open Bankart were the most commonly reported procedures that cite satisfactory postoperative outcomes and limited complications. Publications on the other surgical procedures were less common. Surgeons should be careful when recommending surgery, and they should choose the appropriate surgical procedure based on evidence-based literature.

Simultaneous bilateral anterior shoulder dislocation as a result of minimal trauma

“…In young patients, like our case, the main complication of anterior shoulder dislocation is the instability of the shoulder; a prospective cohort study reported that 55.7% of young patients developed recurrence of shoulder instability within 2 years [ 7 ]. Therefore, it´s necessary to stabilize young patient´s shoulder with surgical treatment, in order to prevent recurrent instability; many options are possible, the most recommended are arthroscopic Bankart and the open Latarjet procedures [ 8 ]. The Latarjet procedure involves transplant of the coracoid process to the scapular neck and has demonstrated excellent long-term clinical outcomes and return to sport rate.…”

Reliability, Validity and Responsiveness of the Polish Version of the Western Ontario Shoulder Instability Index (WOSI-PL) in Patients after Arthroscopic Repair for Shoulder Instability

“…Its classification includes anterior, posterior or multidirectional instability. Pathologic conditions that may contribute to instability in the glenohumeral joint include joint laxity, labral tears, ligament injuries, impaired muscular control as well as bone defects within the humeral head or in the glenoid [ 1 , 2 ]. Shoulder instability may cause pain, popping and crepitus, a sensation of the joint giving way, limb weakness, repeated episodes of joint dislocation, reduced participation in activities of daily living and sports, and a deterioration in quality of life.…”

“…Shoulder instability may cause pain, popping and crepitus, a sensation of the joint giving way, limb weakness, repeated episodes of joint dislocation, reduced participation in activities of daily living and sports, and a deterioration in quality of life. Deterioration of joint function may develop over time [ 2 ].…”

Factors related to large bone defects of bipolar lesions and a high number of instability episodes with anterior glenohumeral instability

“…Glenohumeral instability is a common pathology in young people [ 1 ], and good clinical results can be expected by stabilizing surgery [ 2 ]. However, recurrence occurs often after stabilization, and significant bone defects in the glenoid are associated with failed surgical stabilization [ 3 – 8 ] and poor clinical outcomes [ 9 ].…”