Return to Play Following Shoulder Stabilization: A Systematic Review and Meta-analysis

Abstract

Background:Anterior shoulder instability can be a disabling condition for the young athlete; however, the best surgical treatment remains controversial. Traditionally, anterior shoulder instability was treated with open stabilization. More recently, arthroscopic repair of the Bankart injury with suture anchor fixation has become an accepted technique.Hypothesis:No systematic reviews have compared the rate of return to play following arthroscopic Bankart repair with suture anchor fixation with the Bristow-Latarjet procedure and open stabilization. We hypothesized that the rate of return to play will be similar regardless of surgical technique.Study Design:Systematic review; Level of evidence, 4.Methods:We performed a systematic review and meta-analysis focused on return to play following shoulder stabilization. Inclusion criteria included studies in English that reported on rate of return to play and clinical outcomes following primary arthroscopic Bankart repair with suture anchors, the Latarjet procedure, or open stabilization. Statistical analyses included Student t tests and analyses of variance.Results:Sixteen papers reporting on 1036 patients were included. A total of 545 patients underwent arthroscopic Bankart repair with suture anchors, 353 with the Latarjet procedure, and 138 with open repair. No significant difference was found in patient demographic data among the studies. Patients returned to sport at the same level of play (preinjury level) more consistently following arthroscopic Bankart repair (71%) or the Latarjet procedure (73%) than open stabilization (66%) (P < .05). Return to play at any level and postoperative Rowe scores were not significantly different among studies. Recurrent dislocation was significantly less following the Latarjet procedure (3.5%) than after arthroscopic Bankart repair (6.6%) or open stabilization (6.7%) (P < .05).Conclusion:This systematic review demonstrates a greater rate of return to play at the preinjury level following arthroscopic Bankart repair and the Latarjet procedure than open stabilization. Despite this difference, >65% of all treated athletes returned to sport at their preinjury levels, with other outcome measures being similar among the treatment groups. Therefore, arthroscopic Bankart repair, the Latarjet procedure, and open stabilization remain good surgical options in the treatment of the athlete with anterior shoulder instability.

Borderline Glenoid Bone Defect in Anterior Shoulder Instability: Latarjet Procedure Versus Bankart Repair

“…Furthermore, 1 meta-analysis reported no significant differences at the preinjury level or at any level of return to sports for patients treated with arthroscopic Bankart repair or the Latarjet procedure. 19 In the current study, most patients returned to sports activities after the arthroscopic Bankart repair (94.1%) and Latarjet procedure (96.8%). There was no significant difference in the level of return to sports between operations, thus confirming that the surgical method does not have an effect on the level of postoperative return to sports.…”

Arthroscopic Double-Pulley Remplissage Using a 2-Portal Technique for Hill-Sachs Lesions in Recurrent Anterior Shoulder Instability

“…Whereas some larger studies have reported losses in ER after remplissage, others have reported no statistically significant difference 20, 28, 29, 30, 31, 32, 33. Remplissage continues to have comparable return-to-sport rates to the open Latarjet procedure; however, some concern exists for throwing athletes 34, 35, 36. In their 2016 case series, Garcia et al 36 .…”

Management of Recurrent Anterior Shoulder Instability After Surgical Stabilization in Children and Adolescents

“…Indeed, 75% of studies included in a recent systematic review used time alone as their criteria for return to play, with 6 months being the most commonly recommended time-frame [49]. After primary surgical stabilization, rates of return-to-play at pre-injury level are between 65 and 75% [51]. In a recent systematic review by the senior author on revision instability surgery, these rates were Fig.…”