A high rate of residual instability is associated with first-time anterior shoulder dislocations. As a result, many surgeons advocate for immediate Bankart repair over conservative therapy to address this problem. However, due to ambiguity about long-term surgical outcomes, the best treatment is still up for debate. The major goal of this systematic review and meta-analysis was to assess the short and long-term rates of residual instability after a first-time anterior shoulder dislocation after Bankart repair against conservative care. PubMed/MEDLINE, Embase, The Cochrane Library, Web of Science, CINAHL, and ScienceDirect, were searched for RCTs comparing Bankart repair to conservative care. The RoB 2 (Risk of Bias) method assessed study quality. The major outcomes were evaluated using the principles of GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). They used the Inverse-Variance approach for continuous variables and the Mantel-Haenszel method for dichotomous variables. 

About 348 participants were included, with an average age of 23.7, from six RCTs published in eight papers. In three investigations, bias was rated as “low,” “some concerns” in three studies, and “high” in two studies. Surgery reduced recurrent instability in the near term (two to three years) (Risk Ratio (RR),0.15; 95% CI,0.08-0.27; I2=0%; P<.0001). Long-term (5-12 years) findings were similar (RR,0.23;95% CI,0.14-0.39;I2=0% ;P<.0001). There was no difference in terms of “return to sport” (RR,1.18;95% CI,0.91-1.52;I2=78 %;P=0.21). In the short (RR,0.19; 95% CI, 0.09-0.43; I2=0%; P<.0001) and long-term (RR,0.17;95% CI,0.07-0.39; I2=25% ;P<.0001) term, first surgery reduced the need for later stabilization surgery (RR,0.19; 95% CI, 0.09-0.43; I2=0%; P<.0001).  The Western Ontario Shoulder Instability Index (WOSI) scores were not different in the short term (MD,2.54; 95% CI,-0.51–5.59; I% =48%; P=0.1) but were higher in the surgery group at long-term follow-up. Surgery also increased patient satisfaction (RR,1.75; 95 % CI,1.4–2.2; I2=88%; P<.0001). Only one long-term outcome measure had a poor level of evidentiary certainty. In both short (2-3 years) and long-term (5-12 years) follow-up periods, Bankart repair surgery for first-time anterior shoulder dislocation reduces the chance of recurrent shoulder instability and future stabilization surgery. Long-term follow-up also revealed minor improvements in overall patient satisfaction and WOSI score. Compared to conservative care, surgical surgery did not significantly improve the “return to sport.”

Source:www.jshoulderelbow.org/article/S1058-2746(22)00341-X/fulltext#relatedArticles