Sex-Based Differences in Recurrence Rates Following Arthroscopic Anterior Shoulder Stabilization: A Systematic Review

Abstract

Purpose The purpose of this systematic review was to examine the effect that sex has on recurrence of anterior shoulder instability following primary arthroscopic anterior shoulder stabilization. Methods A systematic review using PRISMA guidelines was performed by searching PubMed, Embase and Cochrane Library databases to identify studies reporting recurrence rates following arthroscopic anterior shoulder stabilization with a minimum follow-up period of 2 years. Patient demographics as well as preoperative, intraoperative and postoperative findings, including patient-reported outcomes and recurrence rates, were analyzed by 2 independent reviewers. Recurrence was defined as an episode of dislocation, subluxation or instability following primary arthroscopic anterior shoulder stabilization. Study methodological quality was evaluated with the Modified Coleman Methodology Score (MCMS). Risk bias was evaluated using the Methodological Index for Non-randomized Studies (MINORS score). Descriptive statistics are presented. Results Ten studies (1 Level I, 1 Level II, 5 Level III, and 3 Level IV), including a total of 7,102 patients with primary traumatic and/or recurrent traumatic shoulder instability without previous procedures who underwent primary arthroscopic anterior shoulder stabilization, were included (mean follow-up, 34.6 months; mean age, 25.4 years). There was a total of 5,097 males (71.8%) and 2,005 females (28.2%). There was a higher recurrence rate in males (6%-37%) compared to females (0-32%). Clinical outcomes were inconsistently reported, so no quantitative analysis of clinical outcomes or return-to-sport between sexes was possible. The average MCMS of all 10 studies was 76.8 ± 8.0, indicating good methodology. Conclusions Males may have higher recurrence rates than females following primary arthroscopic anterior shoulder stabilization; however, the heterogeneity of the included studies precludes any definitive conclusions. Level of evidence IV, Systematic Review of Level I-IV.

Inconsistencies in Controlling for Risk Factors for Recurrent Shoulder Instability After Primary Arthroscopic Bankart Repair: A Systematic Review

“…A recent systematic review focused directly on sex as a risk factor and noted a trend toward male sex being a risk factor for failure. 8 However, the authors were unable to make definitive statistical conclusions or perform a true meta-analysis owing to study heterogeneity.…”

Assessment of Characteristics and Methodological Quality of the Top 50 Most Cited Articles on Platelet-Rich Plasma in Musculoskeletal Medicine

“… 71 MCMS ranges from 0 to 100, and scores <55 are considered poor, between 55 and 69 are fair, between 70 and 84 are good, and between 85 and 100 are excellent. 16 An overall MINORS score of 24 is considered a perfect score and suggests low risk of bias. 16 An overall MIBO score of 23 is considered a perfect score and suggests high transparency, reproducibility, and comparability.…”

“… 16 An overall MINORS score of 24 is considered a perfect score and suggests low risk of bias. 16 An overall MIBO score of 23 is considered a perfect score and suggests high transparency, reproducibility, and comparability. 72 Controlled laboratory studies, literature reviews, and animal studies were not evaluated for methodological quality.…”

Glenohumeral morphological predictors of recurrent shoulder instability following arthroscopic Bankart repair

“…However, increased humeral head diameter and chondral version on preoperative MRAs were protective against future recurrence. There are many well-established risk factors for instability following ABR, which include but are not limited to male sex, young age, hyperlaxity, recurrent dislocations and participation in competitive and collision sports [2,4,10,11,21,24,32]. Additionally, longer time between the first dislocation and surgery has also been associated with increased failure [21,37].…”