A Cochrane review [Abstract] 1 included 4 studies with a total of 163 young, mainly male subjects with first traumatic anterior shoulder dislocation. Pooled results from all four trials showed that subsequent instability, either redislocation or subluxation, was statistically significantly less frequent in the surgical group (RR 0.25; 95% CI 0.14 to 0.44). This result remained statistically significant (RR 0.32, 95%CI 0.17 to 0.59) for the three trials reported in full. Half (17/33) of the conservatively treated patients with shoulder instability in these three trials opted for subsequent surgery. Functional assessment measures, mainly patient-rated, were more favourable, usually statistically significantly so, in the surgically treated group. The only complication reported was a septic joint in a surgically treated patient. There was no information on shoulder pain, long-term complications such as osteoarthritis or on service utilisation and resource use. The limited evidence available supports primary surgery for young adults, usually male, engaged in highly demanding physical activities who have sustained their first acute traumatic shoulder dislocation. There is no evidence available to determine whether non-surgical treatment should not remain the prime treatment option for other categories of patient.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions: types of surgery differed) and by imprecise results (limited study size for each comparison).
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