Surgical stabilization of pediatric anterior shoulder instability yields high recurrence rates: a systematic review

Abstract

Purpose The purpose of this systematic review was to assess the surgical techniques, indications outcomes and complications for pediatric patients (≤ 19 years old) undergoing shoulder stabilization procedures for anterior shoulder instability. Methods The electronic databases MEDLINE, EMBASE, CINAHL, and Web of Science were searched from data inception to March 14, 2019 for articles addressing surgery for pediatric patients with anterior shoulder instability. The Methodological Index for Non-randomized Studies (MINORS) tool was used to assess the quality of included studies. Results Overall 24 studies, with a total of 688 patients (696 shoulders) and a mean age of 16.6 ± 2.5 years met inclusion criteria. Mean follow-up was 49 ± 26 months. The majority (59%) of studies only ofered shoulder stabilization procedures to patients with more than one shoulder dislocation, however, three studies reported operating on pediatric patients after irst time dislocations. Of the included patients 525 had arthroscopic Bankart repair (78%), 75 had open Bankart repair (11%), 34 had modiied Bristow (5%), and 26 had Latarjet (4%) procedures. The overall complication rate was 26%. Patients undergoing arthroscopic Bankart repair experienced the highest recurrence rate of 24%. There were no signiicant diferences in recurrent instability (n.s.) or loss of external rotation (n.s.) in pediatric patients treated with arthroscopic Bankart repair compared to open Latarjet. Patients had a 95% rate of return to sport at any level (i.e. preinjury level or any level of play) postoperatively (95%). Conclusions Pediatric patients are at high risk of recurrent instability after surgical stabilization. The majority of pediatric patients with anterior shoulder instability were treated with arthroscopic Bankart repair. Most studies recommend surgical stabilization only after more than one dislocation. However, given the high rates of recurrence with non-operative management, it may be reasonable to perform surgery at a irst-time dislocation, particularly in those with other risk factors for recurrence. With the current evidence and limited sample sizes, it is diicult to directly compare the surgical interventions and their post-operative eicacy (i.e. re-dislocation rates or range of motion). There was an overall high rate of return to sport after surgical stabilization at inal follow-up. Level of evidence IV.

Clinical Outcomes, Survivorship, and Return to Sport After Arthroscopic Capsular Repair With Suture Anchors for Adolescent Multidirectional Shoulder Instability: Results at 6-Year Follow-up

“…Failure of arthroscopic treatment for anterior instability in adolescent patients has been reported at rates of 21% to 24%, with a 77% rate of return to preinjury sport levels and a 95% rate of return to some sport participation. 26,27 Functional outcomes measured are reasonable at >2 years of follow-up, with a QuickDASH score of 10 and a SANE score of 72. 27 Adolescent posterior instability has shown a slightly lower reported rate of failure (12.5%), with reported functional outcomes including QuickDASH score of 17; PASS, 79; and SANE, 79.…”

Criteria-based return-to-sport testing is associated with lower recurrence rates following arthroscopic Bankart repair

“…The current literature on recurrent shoulder instability is focused on preoperative variables and surgical technique. Recent investigations have highlighted nonmodifiable 14 as well as modifiable risk factors influencing recurrent instability, such as open vs. arthroscopic approaches, 9 the number and type of anchors, 1 concomitant procedures to address variable amounts of glenoid and humeral bone loss, 4,12,15 and the type and level of sports participation. 2 Our cohorts were demographically matched with strict exclusion criteria to minimize any preoperative and surgical confounding risk factors, as mentioned earlier, in an effort to isolate postoperative factors as the only variable studied.…”

“…The subscapularis was not violated during anterior repairs. We excluded patients with glenoid bone loss > 13.5%, 15 calculated by the best-fit circle method on magnetic resonance imaging; general joint hyperlaxity, defined as a score ! 4 according to the Beighton criteria; off-track Hill-Sachs lesions 4 ; concomitant injury, such as rotator cuff tear requiring repair; or prior shoulder surgery.…”

“…13 Historically, recurrence rates after Bankart repair between 3% and 23% have been reported. 1,5 The current literature is focused on preoperative variables and surgical technique to identify modifiable factors, such as open vs. arthroscopic approaches, 9 the number and type of anchors used, 14 the amount of glenoid loss and the size of the Hill-Sachs defect, 4,12,15 and the type and level of sports participation. 9 However, nonsurgical factors such as rotator cuff weakness have been associated with recurrent shoulder instability in the preoperative setting.…”

Return to sports after arthroscopic Bankart repair in teenage athletes: a retrospective cohort study

“…Adolescent athletes have also reported different recurrence rates depending on the surgical technique. According to a review of surgical stabilization of pediatric anterior shoulder instability [ 23 ], the recurrence rate was 24% in ABR, 12% in open Bankart repair, 6% in modified Bristow, and 8% in Latarjet procedure. Considering this high recurrence rate in pediatric athletes, the recurrence rate in this study was low at 7.2%.…”