Treatment After Traumatic Shoulder Dislocation: a Systematic Review with a Network Meta-analysis

Overview

Journal Br J Sports Med

Publisher BMJ Publishing Group

Specialty Orthopedics

Date 2018 Jun 25

PMID 29936432

Citations 14

Authors

Lauri Kavaja

Tuomas Lahdeoja

Antti Malmivaara

Mika Paavola

Affiliations

Soon will be listed here.

Abstract

Objective: To review and compare treatments (1) after primary traumatic shoulder dislocation aimed at minimising the risk of chronic shoulder instability and (2) for chronic post-traumatic shoulder instability.

Design: Intervention systematic review with random effects network meta-analysis and direct comparison meta-analyses.

Data Sources: Electronic databases (Ovid MEDLINE, Cochrane Clinical Trials Register, Cochrane Database of Systematic Reviews, Embase, Scopus, CINAHL, Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, DARE, HTA, NHSEED, Web of Science) and reference lists were searched from inception to 15 January 2018.

Eligibility Criteria For Selecting Studies: Randomised trials comparing any interventions either after a first-time, traumatic shoulder dislocation or chronic post-traumatic shoulder instability, with a shoulder instability, function or quality of life outcome.

Results: Twenty-two randomised controlled trials were included. There was moderate quality evidence suggesting that labrum repair reduced the risk of future shoulder dislocation (relative risk 0.15; 95% CI 0.03 to 0.8, p=0.026), and that with non-surgical management 47% of patients did not experience shoulder redislocation. Very low to low-quality evidence suggested no benefit of immobilisation in external rotation versus internal rotation. There was low-quality evidence that an open procedure was superior to arthroscopic surgery for preventing shoulder redislocations.

Conclusions: There was moderate-quality evidence that half of the patients managed with physiotherapy after a first-time traumatic shoulder dislocation did not experience recurrent shoulder dislocations. If chronic instability develops, surgery could be considered. There was no evidence regarding the effectiveness of surgical management for post-traumatic chronic shoulder instability.

Citing Articles

Management of First-Time Anterior Shoulder Dislocation-A Systematic Review and Meta-analysis: Arthroscopy Association of Canada Position Statement.

Khalik H, Dagher D, Lameire D, Gusnowski E, Kolpka M, LeBel M Orthop J Sports Med. 2025; 13(2):23259671251316893.

PMID: 39968414 PMC: 11833906. DOI: 10.1177/23259671251316893.

Effect of a multicomponent exercise program focused on multivariable fatigue improvement versus standard care for glenohumeral instability: MoveUS study protocol.

Ramirez-Perez L, Cuesta-Vargas A BMC Musculoskelet Disord. 2024; 25(1):1013.

PMID: 39695629 PMC: 11654015. DOI: 10.1186/s12891-024-08193-4.

The Top-20 Studies About Anterior Shoulder Instability From an Altmetric Analysis Had Higher Levels of Evidence Than Those From a Traditional Bibliometric Analysis.

ODwyer L, Ledingham C, Davey M, Kerin A, Huszar A, Cassidy J Arthrosc Sports Med Rehabil. 2024; 6(5):100974.

PMID: 39534029 PMC: 11551400. DOI: 10.1016/j.asmr.2024.100974.

Systematic Review of Arthroscopic Bankart Repair Outcomes for Anterior Shoulder Instability.

Asiri F, Alqhtani A, Assiri A, Alqahtani M, Tedla J, Awwadh B Med Sci Monit. 2024; 30:e945942.

PMID: 39428642 PMC: 11504916. DOI: 10.12659/MSM.945942.

Sutures, Screws, Buttons, and Anchors: A Review of Current Bone Graft Fixation Devices for Glenoid Bone Loss in the Unstable Shoulder.

Rosenow C, Leland D, Camp C, Barlow J Curr Rev Musculoskelet Med. 2024; 17(6):207-221.

PMID: 38587597 PMC: 11091027. DOI: 10.1007/s12178-024-09895-x.

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