Eoghan T Hurley1, Amit K Manjunath2, David A Bloom2, Leo Pauzenberger3, Hannan Mullett3, Michael J Alaia2, Eric J Strauss2. 1. Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A.; Sports Surgery Clinic, Dublin, Ireland. Electronic address: eoghan.hurley@nyulangone.org. 2. Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A. 3. Sports Surgery Clinic, Dublin, Ireland.
Abstract
PURPOSE: To perform a meta-analysis of the current evidence in the literature comparing arthroscopic Bankart repair versus conservative management for first-time anterior shoulder dislocation. METHODS: A literature search of the MEDLINE, Embase, and Cochrane Library databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Prospective studies comparing arthroscopic Bankart repair versus conservative management as treatment for first-time anterior shoulder dislocation were included. Recurrence, further treatment, and return to play were compared, with all statistical analysis performed using Review Manager, version 5.3. P < .05 was considered statistically significant. RESULTS: Ten prospective studies with 569 patients were included. Arthroscopic Bankart repair resulted in a lower rate of total recurrent instability (9.7% vs 67.4, I2 = 0, P < .0001) and further surgical treatment for anterior shoulder instability (5.9% vs 46.7%, I2 = 0, P < .0001). Additionally, arthroscopic Bankart repair resulted in a higher rate of return to play (92.8% vs 80.8%, I2 = 0, P = .002). CONCLUSIONS: Arthroscopic Bankart repair resulted in a 7-fold lower recurrence rate and a higher rate of return to play than conservative management. Thus, arthroscopic Bankart repair may be advisable to perform routinely in patients with first-time dislocation who participate in sports. LEVEL OF EVIDENCE: Level II, systematic review of Level I and II studies.
PURPOSE: To perform a meta-analysis of the current evidence in the literature comparing arthroscopic Bankart repair versus conservative management for first-time anterior shoulder dislocation. METHODS: A literature search of the MEDLINE, Embase, and Cochrane Library databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Prospective studies comparing arthroscopic Bankart repair versus conservative management as treatment for first-time anterior shoulder dislocation were included. Recurrence, further treatment, and return to play were compared, with all statistical analysis performed using Review Manager, version 5.3. P < .05 was considered statistically significant. RESULTS: Ten prospective studies with 569 patients were included. Arthroscopic Bankart repair resulted in a lower rate of total recurrent instability (9.7% vs 67.4, I2 = 0, P < .0001) and further surgical treatment for anterior shoulder instability (5.9% vs 46.7%, I2 = 0, P < .0001). Additionally, arthroscopic Bankart repair resulted in a higher rate of return to play (92.8% vs 80.8%, I2 = 0, P = .002). CONCLUSIONS: Arthroscopic Bankart repair resulted in a 7-fold lower recurrence rate and a higher rate of return to play than conservative management. Thus, arthroscopic Bankart repair may be advisable to perform routinely in patients with first-time dislocation who participate in sports. LEVEL OF EVIDENCE: Level II, systematic review of Level I and II studies.
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