Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis

Abstract

BackgroundRecurrent instability following a first-time anterior traumatic shoulder dislocation may exceed 26%. We systematically reviewed risk factors which predispose this population to events of recurrence.MethodsA systematic review of studies published before 1 July 2014. Risk factors which predispose recurrence following a first-time traumatic anterior shoulder dislocation were documented and rates of recurrence were compared. Pooled ORs were analysed using random-effects meta-analysis.ResultsTen studies comprising 1324 participants met the criteria for inclusion. Recurrent instability following a first-time traumatic anterior shoulder dislocation was 39%. Increased risk of recurrent instability was reported in people aged 40 years and under (OR=13.46), in men (OR=3.18) and in people with hyperlaxity (OR=2.68). Decreased risk of recurrent instability was reported in people with a greater tuberosity fracture (OR=0.13). The rate of recurrent instability decreased as time from the initial dislocation increased. Other factors such as a bony Bankart lesion, nerve palsy and occupation influenced rates of recurrent instability.ConclusionsSex, age at initial dislocation, time from initial dislocation, hyperlaxity and greater tuberosity fractures were key risk factors in at least two good quality cohort studies resulting in strong evidence as concluded in the GRADE criteria. Although bony Bankart lesions, Hill Sachs lesions, occupation, physiotherapy treatment and nerve palsy were risk factors for recurrent instability, the evidence was weak using the GRADE criteria—these findings relied on poorer quality studies or were inconsistent among studies.

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

“…Postacchini et al 2 reported that all children had a Hill-Sachs lesion and 100% rate of recurrence in these children; Wagner and Lyne18 found no Hill-Sachs lesions in the nine children who underwent radiological investigations. Adults with Hill-Sachs lesions were 1.55 times more likely to have recurrent instability following a first-time traumatic anterior shoulder dislocation, although this finding was non-significant (p>0.05) with moderate heterogeneity 28. Further investigations are required into the presence of Hill-Sachs lesions and rates of recurrent instability in children following a first-time traumatic anterior shoulder dislocation.…”

“…However, data presented in this systematic review must be interpreted carefully as there were significantly more participants within the closed physis group (n=59) compared with the open physis group (n=17). In addition, rates of recurrence in people aged between 15 and 40 have been reported to be 44%,28 and therefore the presence of variables other than a closed physis must be considered.…”

Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss

“…1 Nonoperative management of glenohumeral instability has been associated with high rates of recurrence in multiples studies, with recurrence rates ranging from 37% to 85%. [2][3][4][5][6][7][8][9] Arthroscopic stabilization procedures have been similarly associated with recurrent instability, with recurrence rates ranging from 10.8% to 21.1%. [10][11][12][13] As a result, it has become essential for physicians to recognize clinical factors that place patients at increased risk of failed nonoperative or arthroscopic treatment.…”

Arthroscopic Repair versus Non-operative Treatment of First-time Traumatic Anterior Shoulder Dislocations: A Numbers-needed-to-treat Analysis for Prevention of Recurrent Dislocations

“…A recent study reported that the recurrence rate one year after the initial dislocation was 39%. 1) Treatment options include primary arthroscopic surgical capsulolabral repair or non-operative (conservative) treatment. Many systematic reviews [2][3][4] reported that arthroscopic surgical repair is superior to non-operative treatment in terms of recurrent episodes of shoulder dislocations, especially in young patients participating in intense physical activity (e.g., contact sports).…”