A Cochrane review [Abstract] 1 on various surgical interventions for recurrent anterior instability of the shoulder in adults included 3 studies with a total of 184 subjects, predominantly active young men with unidirectional anterior shoulder instability generally following a traumatic event. All three trials compared arthroscopic versus open surgery, generally involving the repair of Bankart lesions. Minimum follow-up was two years. Pooled results showed no statistically significant difference between the two groups in recurrent instability or re-injury (7/92 versus 5/85, risk ratio [RR]) 0.89, 95% CI 0.09 to 8.72; random-effects model), in subsequent instability-related surgery (RR 0.66, 95% CI 0.05 to 8.97) or surgery for all reasons (RR 0.55, 95% CI 0.04 to 7.18). For other outcomes, including shoulder function, there were either no statistically significant differences between the two groups or the differences were clinically insignificant where statistically significant differences occurred.
Comment: The quality of evidence is downgraded by limitations in study quality (inadequate or unclear allocation concealment), by inconsistency (heterogeneity in interventions and outcomes) and by imprecise results (few patients and wide confidence intervals).
Primary/Secondary Keywords