Operative versus Conservative Management of First-Time Anterior Glenohumeral Dislocation, A Systematic Review and Meta Analysis

Abstract Background Traumatic Anterior Shoulder Instability is quite common especially in young males and high demand athletes. Management of first-time anterior shoulder dislocation remains controversial, with no consensus on whether arthroscopic stabilization or only shoulder immobilization should be offered to these patients. Aim of the Work To systematically review the existing literature to compare long-term results after operative stabilization and conservative primary treatment following first-time anterior shoulder dislocation, regarding recurrent instability and redislocation rates as a primary outcome, and secondary clinical outcome parameters like functional shoulder scores. Patients and Methods A total of 5 studies met our inclusion criteria for this systematic review and meta-analysis, performed to identify and analyze level 1 randomized controlled studies comparing the outcomes of arthroscopic stabilization versus conservative management in the form of immobilization for the treatment of primary anterior shoulder dislocation. Patients with soft tissue injury alone as well as those with additional minor bony lesions (Hill-Sachs, Bankart) were included. Recurrent instability and functional outcome were evaluated. Results Our results show that in young patients, arthroscopic Bankart repair after the first episode of ASD significantly reduced the risk of recurrent instability and decreased the need for a future stabilization procedure, but did not seem to significantly affect functional outcome, when compared with patients treated non-operatively with immobilization. Conclusion This review and meta-analysis shows that in patients younger than 40 years, arthroscopic Bankart repair after the first episode of ASD significantly reduced the risk of recurrent instability and decreased the need for a future stabilization procedure when compared with patients treated non- operatively with immobilization.