Primary Repair Versus Conservative Treatment of First-Time Traumatic Anterior Dislocation of the Shoulder: A Randomized Study With 10-Year Follow-up

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

“…1 and 2, respectively. Across all six studies, [12][13][14][15][16][17] the arthroscopic surgical treatment showed a decreased rate of recurrent shoulder dislocations or subluxations when compared to the non-operative treatment. Calculated pooled result of NNT was a positive number of 1.76 (95% CI=1.50 to 2.13), indicating that two arthroscopic surgical repairs would need to be performed in order to prevent one recurrent episode.…”

“…Error bars (95% confidence intervals) do not cross the midline (zero) indicate that the corresponding average number is statistically significant (p<0.05). Bottoni et al 13) Jakobsen et al 15) Larrain et al 17) Pooled Kirkley et al 16) DeBerardino et al 14) 82.1% tidirectional (e.g., inferior and/or posterior) or chronic shoulder instability. In addition, the pooled results cannot be generalized for other acute shoulder pathologies such as rotator-cuff or SLAP (superior labrum anterior to posterior) tear.…”

“…According to traumatic or atraumatic classifications, 33) we reviewed and analyzed studies that evaluated patients with firsttime traumatic anterior shoulder dislocations. Therefore, we do not know the effects of the two different interventions on mul- Arciero et al 12) Bottoni et al 13) Jakobsen et al 15) Larrain et al 17) Pooled Kirkley et al 16) DeBerardino et al 14) Fig. 2.…”

“…More specifically, these articles included a comparison between different surgical techniques (e.g., open vs. arthroscopic), patients with shoulder dislocations rather than anterior direction (e.g., posterior instability), patients with multiple dislocations (e.g., not first-time), different outcome measures (e.g., cost effectiveness), only recorded outcome measures from the surgical treatment (e.g., absence of the control). Among the remaining 11 relevant studies, [12][13][14][15][16][17][18][19][20][21][22] five articles [18][19][20][21][22] were further excluded. One study, 18) which was a longer-term follow-up to the same patients used in another study, 16) and was included in the pooled data, was excluded.…”

“…20) One article was excluded because only an abstract was published. 19) Therefore, six studies [12][13][14][15][16][17] were finally pooled. The average follow-up time was 56 months.…”