Arthroscopic Bankart Repair Versus Conservative Management for First-Time Traumatic Anterior Shoulder Instability: A Systematic Review and Meta-analysis

Hurley, Eoghan T.; Manjunath, Amit K.; Bloom, David A.; Pauzenberger, Leo; Mullett, Hannan; Alaia, Michael J.; Strauss, Eric J.

doi:10.1016/j.arthro.2020.04.046

Cited by 96 publications

(84 citation statements)

References 33 publications

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“…Most shoulder dislocations (>95%) occur in the anterior direction and are usually the result of trauma 123. Optimal management can prevent recurrent dislocations and reduce social costs 456. Patients with first time dislocations often receive insufficient information to make a decision about their management 7.…”

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confidence: 99%

Assessment and management of shoulder dislocation

Verweij

Baden

Zande

et al. 2020

BMJ

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confidence: 99%

Assessment and management of shoulder dislocation

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Baden

Zande

et al. 2020

BMJ

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“…This concept is further enhanced by patients who are in a high risk (of recurrence) category, such as young age (<25 years old), male sex, and certain sports participation. 1,2 The authors Hurley, Manjunath, Bloom, Pauzenberger, Mullett, Alaia, and Strauss of the article "Arthroscopic Bankart Repair Versus Conservative Management for First-Time Traumatic Shoulder InstabilitydA Systematic Review and Meta-Analysis" 3 should be congratulated for performing a high-level outcomes analysis in patients who were treated either with or without surgery for a first-time anterior instability event. In their article, Hurley et al have determined that overall recurrence risk was 9.7% following arthroscopic Bankart repair versus 67.4% following nonoperative treatment.…”

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confidence: 99%

“…These findings emphasize the importance of identifying injury to the stabilizing structures of the glenohumeral joint, and it is our opinion that the threshold for obtaining advanced imaging following a first-time anterior shoulder dislocation should be lowered. In the systematic review by Hurley et al, 3 almost 50% of the patients treated nonoperatively subsequently underwent surgical stabilization. A wait-and-see approach could be acceptable if delay of surgical stabilization was without detrimental consequences, but this is unlikely to be the case.…”

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“…In addition to recurrence rate, Hurley et al 3 investigated the need for additional surgery and return to sport and found a statistically significant differences in favor of arthroscopic Bankart repair. These outcomes are indeed important; however, one could argue that patient-reported outcome measures would be even more significant when comparing treatment strategies.…”

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“…In 2019, the Neer Circle of the American Shoulder and Elbow Surgeons reached a consensus for surgical recommendation for athletes younger than 30 years with apprehension and bone loss. Hurley et al 3 have done an outstanding review to help clarify the need for early intervention after an instability event, but we still have several unanswered questions that beg for additional well-designed prospective studies to help us improve upon the treatment algorithm for anterior shoulder instability.…”

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Editorial Commentary: Evidence to Support Surgical Intervention for First-Time Shoulder Instability: Stabilize Them Early!

Provencher

Midtgaard

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Historically, a primary anterior instability event has been treated nonoperatively. In the literature, a multitude of outcome scores and definitions for recurrence of instability complicates the interpretation and synthesis of evidencebased recommendations. However, there is an emerging body of high-quality evidence that early surgical stabilization yields better overall outcomes. A wait-and-see approach would be acceptable if it was without detrimental effects, but there is a cost to recurrence of instability events, such as more extensive soft-tissue, cartilage, and bony lesions. Young age, male sex, and contact sport participation have been identified as risk factors for recurrence of anterior shoulder instability, and today, these patients are routinely recommended surgical treatment. It is also paramount to identify concomitant injury following the primary anterior instability event. The sensitivity, specificity, and reliability of radiographs is suboptimal, and the threshold to obtain advanced imaging such as computed tomography or magnetic resonance imaging with 3-dimensional reconstructions should be low. Taking into account the low non-recurrence complication rate following arthroscopic stabilization, early surgical intervention should be considered following the first instability event.

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Arthroscopic Bankart with remplissage results in lower rates of recurrent instability with similar range of motion compared to isolated arthroscopic Bankart for anterior glenohumeral instability: A systematic review and meta‐analysis

Villarreal‐Espinosa,

Kay,

Ramappa

2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe addition of the remplissage procedure to an arthroscopic Bankart procedure has been shown to improve clinical outcomes, yet at the expense of potentially decreasing shoulder range of motion. The purpose of this study was to assess recurrent instability, range of motion, functional outcomes and rates of return to sport outcomes in patients undergoing an isolated arthroscopic Bankart repair compared to those undergoing arthroscopic Bankart repair in addition to the remplissage procedure.MethodsAccording to the Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) guidelines, a search was conducted using three databases (MEDLINE/OVID, EMBASE and PubMed). Retrieved studies were screened based on predefined inclusion and exclusion criteria for comparative studies. Data were extracted and meta‐analysis performed using a random‐effects model.ResultsA total of 16 studies (13 level III studies, 2 level II studies and 1 level I) were included with a total of 507 and 704 patients in the Bankart plus remplissage and isolated Bankart repair groups, respectively. No studies reported glenoid bone loss of >20% with the least percentage of glenoid bone loss reported among studies being <1%. There was a significantly increased rate of recurrent dislocations (odds ratio [OR] = 4.22, 95% confidence interval [CI]: 2.380–7.48, p < 0.00001) and revision procedures (OR = 3.36, 95% CI: 1.52–7.41, p = 0.003) in the isolated Bankart repair group compared to the Bankart plus remplissage group. Additionally, there were no significant differences between groups in terms of external rotation at side (n.s.), in abduction (n.s.) or at forward flexion (n.s.) at final follow‐up. Furthermore, return to preinjury level of sport favoured the Bankart plus remplissage group (OR = 0.54, 95% CI: 0.35–0.85, p = 0.007).ConclusionPatients undergoing arthroscopic Bankart plus remplissage for anterior shoulder instability have lower rates of recurrent instability, higher rates of return to sport, and no significant difference in range of motion at final follow‐up when compared to an isolated arthroscopic Bankart repair. Further large, prospective studies are needed to further determine which patients and degree of bone loss would benefit most from augmentation with the remplissage procedure.Level of EvidenceLevel III.

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Arthroscopic Bankart Repair Versus Conservative Management for First-Time Traumatic Anterior Shoulder Instability: A Systematic Review and Meta-analysis

Cited by 96 publications

References 33 publications

Assessment and management of shoulder dislocation

Assessment and management of shoulder dislocation

Editorial Commentary: Evidence to Support Surgical Intervention for First-Time Shoulder Instability: Stabilize Them Early!

Arthroscopic Bankart with remplissage results in lower rates of recurrent instability with similar range of motion compared to isolated arthroscopic Bankart for anterior glenohumeral instability: A systematic review and meta‐analysis

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