In children 18 years and under, what promotes recurrent shoulder instability after traumatic anterior shoulder dislocation? A systematic review and meta-analysis of risk factors

Abstract

Background Skeletal maturity and age-related changes in the composition of the glenoid labrum and joint capsule may influence rates of recurrent instability in children. We systematically review risk factors which predispose children to recurrent shoulder instability. Methods The systematic review-concerned studies published before May 2015. Statistical analysis was undertaken to compare rates of recurrence for each extracted risk factor. Pooled ORs were analysed using random effects meta-analysis. Results 6 retrospective cohort studies met the inclusion criteria. 8 risk factors were identified across the studies including age, sex, shoulder dominance and injury side, mechanism of injury, state of physis closure, and HillSachs and Bankart lesions. The rate of recurrent instability was 73%. Children aged 14-18 years were 24 times more likely to experience recurrent instability than children aged 13 years and less (93% vs 40%; OR=24.14, 95% CI (3.71 to 156.99), Z=3.33, p=0.001, I 2 =6.83%). There was a non-significant trend indicating males were 3.4 times more likely to experience recurrent instability (OR=3.44, 95% CI (0.98 to 12.06), Z=1.93, p=0.053, I 2

Recurrence and return to play after shoulder instability events in young and adolescent athletes: a systematic review and meta-analysis

“…This result follows the findings of a population-based study which found recurrence rates of up to 25% in patients aged <14 years but 42.3% in patients aged 14–16 years 44. Our findings were also very similar to the analysis conducted by Olds et al ,45 albeit with the magnitude of our OR being slightly attenuated due to our inclusion of the study by Roberts et al . However, we diverge from the support granted by Olds et al that these data necessarily support the position taken by some groups that recurrence rates in the <14-year-old cohort are low.…”

Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation

“…This wide variation may be explained by the heterogeneous populations in these studies 5. Risk factors for recurrent instability following an FTASD have been described in recent systematic reviews and meta-analyses 6–8. These risk factors may be categorised as either modifiable or non-modifiable.…”

“…There are very few high-quality prospective studies examining risk factors for recurrent instability following an FTASD 6 7. We aimed to develop a multivariate prognostic tool which can be used to predict recurrent instability, based on known risk factors.…”

Arthroscopic Management and Radiographic Interpretation of an Everted Bony Bankart Lesion

“…Magnetic resonance imaging (MRI) confirmed this, but on critical examination of axial cuts, the fragment appeared flipped with subchondral bone superficial to articular cartilage ( Figure 2 ). Based on his pain and the redislocation rate of his age group after traumatic dislocations, surgery was recommended [ 2 ].…”