Outcomes After Revision Anterior Shoulder Stabilization: A Systematic Review.
Date
2020-05
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Abstract
Background
Primary shoulder stabilization is successful, but there continues to be a risk of recurrence after operative repair, particularly in the young athlete. It is important for surgeons to understand the outcomes after various revision stabilization techniques to best counsel patients and manage expectations.Purpose
To analyze recurrent instability and revision surgery rates in patients who underwent revision anterior glenohumeral stabilization procedures with either arthroscopic repair, open repair, coracoid transfer, free bone block, or capsular reconstruction.Study design
Systematic review; Level of evidence, 4.Methods
We performed a systematic review of level 2 to 4 evidence studies using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Clinical studies of revision anterior glenohumeral stabilization (arthroscopic repair, open repair, coracoid transfer, free bone block, or capsular reconstruction) with a minimum 2-year follow-up were analyzed. The rate of recurrent instability, rate of revision surgery, patient-reported outcomes, and range of motion were extracted and reported. Study methodological quality was evaluated using the Downs and Black quality assessment score.Results
A total of 37 studies met inclusion criteria and were available for analysis: 20 studies evaluated arthroscopic repair, 8 evaluated open repair, 5 evaluated Latarjet procedure, 3 evaluated bone block, and 2 evaluated capsular reconstruction. There was 1 study included in both arthroscopic and Latarjet procedures, for a total of 1110 revision cases. There was 1 level 2 study, and the remainder were level 3 or 4 with poor Downs and Black scores. Participants analyzed were most commonly young (weighted mean age, 26.1 years) and male (78.4%). The weighted mean clinical follow-up after revision surgery was 47.8 months. The weighted mean rate of recurrent instability was 3.8% (n = 245) after the Latarjet procedure, 13.4% (n = 260) after open repair, 16.0% (n = 531) after arthroscopic repair, 20.8% (n = 72) after bone block, and 31.0% (n = 35) after capsular reconstruction. The weighted mean rate of additional revision surgery was 0.0% after bone block, 0.02% after the Latarjet procedure, 9.0% after arthroscopic repair, 9.3% after open repair, and 22.8% after capsular reconstruction. Patient-reported outcomes and objective measures of range of motion and strength improved with all revision techniques.Conclusion
The current review identifies a deficiency in the literature pertaining to consistent meaningful outcomes and the effect of bone loss after revision shoulder stabilization. Published studies demonstrate, however, that revision shoulder stabilization using arthroscopic, open, coracoid transfer, or bone block techniques yielded satisfactory objective and patient-reported outcomes. The Latarjet procedure exhibited the lowest recurrent instability rate. This study confirms that recurrent instability remains a common problem, despite revision shoulder stabilization. The quality of research in revision shoulder stabilization remains poor, and higher quality studies are needed to establish best practices for treatment of this complex problem.Type
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Lau, Brian C, Tyler R Johnston, Bonnie P Gregory, Lorena Bejarano Pineda, Mark Wu, Amanda N Fletcher, Jessica H Hu, Leila Ledbetter, et al. (2020). Outcomes After Revision Anterior Shoulder Stabilization: A Systematic Review. Orthopaedic journal of sports medicine, 8(5). p. 2325967120922571. 10.1177/2325967120922571 Retrieved from https://hdl.handle.net/10161/30094.
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Scholars@Duke
Brian Chei-Fai Lau
Leila Ledbetter
Leila is the library liaison to the School of Nursing.
As a research specialist, Leila works with faculty, staff and students to provide library services such as: systematic reviews of the literature; classes on evidence-based practice, resources and tools; research consultations; and office hours.
AHIP, Academy of Health Information Professionals Distinguished Member
MLIS, School of Information Studies, University of Wisconsin at Milwaukee
BS, Biology, Marietta College
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