2023 ISAKOS Biennial Congress ePoster
A Comprehensive Comparison and Evaluation of Surgical Techniques for Anterior Shoulder Instability: A Bayesian Network Meta-Analysis
Moin Khan, MD, MSc, FRCSC, Hamilton, ON CANADA
Saad Masud, BSc, Detroit, MI UNITED STATES
David Momtaz, MPH, San Antonio UNITED STATES
Marcel Betsch , MD, Mannheim GERMANY
Filippo Migliorini, MD, MBA, PhD, Cologne, NRW GERMANY
Abdullah Ghali, MD, Houston UNITED STATES
Kyle Gouveia, MD, Hamilton, ON CANADA
Timothy Leroux, MD, MEd, FRCSC, Toronto CANADA
Ryan M. Degen, MD, FRCSC, London, ON CANADA
McMaster University , Hamilton, ON, CANADA
FDA Status Not Applicable
Summary
There are many surgical procedures that can potentially be performed for anterior shoulder instability, but there is, limited head-to-head, high-quality data comparing these procedures. The aim of this systematic review and network meta-analysis is to provide a comprehensive overview, analysis and comparison of multiple surgical techniques that are used to manage anterior shoulder instability.
ePosters will be available shortly before Congress
Abstract
Background
Anterior shoulder instability is a common clinical problem; however, conflicting evidence exists regarding optimal treatment algorithms.
Purpose
To perform a comprehensive assessment and comparative analysis of stabilization techniques used to manage recurrent anterior shoulder instability.
Methods
Study design is a Bayesian network meta-analysis.PubMed, MEDLINE, Embase, and Cochrane databases were searched for clinical studies comparing surgical techniques for anterior shoulder instability. Two team members independently assessed all potential studies for eligibility and extracted data. Each included study underwent a risk of bias assessment using the Cochrane risk of bias summary tool. The primary outcome of interest was the rate of recurrent instability which underwent a Bayesian network meta-analysis. Additional analyses were performed relating to the degree of glenoid bone loss and the presence of osseous lesions.
Results
Of 2699 studies screened, 52 studies with 4209 patients were included. Patients who underwent open Latarjet demonstrated the overall lowest rate of recurrent instability (LOR 1.93; 95% CI 1.37 to 2.48), while patients who underwent arthroscopic Bankart repair demonstrated the highest (LOR 2.87; 95% CI 2.40 to 3.34). In the setting of 10-20% glenoid bone loss, open Latarjet had significantly lower recurrent instability (P=0.0016) compared to arthroscopic Bankart repair. When glenoid bone loss increased from 0-10% to 10-20%, arthroscopic Bankart repair had a significantly increased rate of recurrence (P=0.021). In the presence of an engaging Hill-Sachs lesion, both open Latarjet (P=0.01) and arthroscopic Bankart with remplissage (P=0.029) had significantly reduced recurrence rates when compared to arthroscopic Bankart repair alone. Open Latarjet had a high complication rate of 6.66%, while arthroscopic Bankart was lower at 1.24%. Finally, regardless of procedure, the presence of a Hill-Sachs or bony Bankart lesion was associated with an increased risk of recurrent instability (r = 0.44; P = 0.0003 and r = 0.40; P = 0.006, respectively).
Conclusion
The open Latarjet technique was found to have the overall lowest rate of recurrent instability, and significantly lower when compared to arthroscopic Bankart repair in the setting of increasing glenoid bone loss. It is, however, associated with a higher complication rate, which needs to be weighed when considering the procedure.