Arthroscopy: The Journal of Arthroscopic & Related Surgery
Systematic ReviewManagement of Primary Acute Anterior Shoulder Dislocation: Systematic Review and Quantitative Synthesis of the Literature
Section snippets
Methods
We performed a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with a PRISMA checklist and algorithm.17 The search algorithm according to the PRISMA guidelines is shown in Fig 1. A comprehensive search of PubMed, MEDLINE, CINAHL, Cochrane Library, EMBASE, and Google Scholar databases using various combinations of the keywords “shoulder,” “dislocation,” “treatment,” “acute,” and “primary” over the years
Results
The literature search and cross-referencing resulted in a total of 1,109 references, 1,068 of which were rejected because of off-topic abstracts, failure to fulfill the inclusion criteria, or both (Fig 2). After reading the remaining full-text articles, another 10 articles were excluded because of insufficient details and uncertain diagnosis and outcome measures.
Finally, 31 articles on the treatment of patients with primary acute anterior shoulder dislocation were included. An exclusively
Discussion
The most important finding of this study is that surgical management of primary acute dislocation of shoulder is associated with a lower rate of recurrence when compared with conservative treatment. Moreover, the immobilization in external rotation provides a lower rate of recurrence compared with the immobilization in internal rotation.
We performed a quantitative synthesis of the literature to compare conservative and surgical approaches. The surgical treatment reported in the included studies
Conclusions
Although limited, the available evidence from RCTs supports primary surgery in young adults engaged in highly demanding sports or job activities. There is a lack of evidence to determine whether surgical or nonsurgical treatment is better for other categories of injuries.
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2022, Journal of Shoulder and Elbow SurgeryCitation Excerpt :However, the conclusions of these meta-analyses were controversial. Some concluded that ER immobilization was effective in reducing the recurrence rate,28,32,40 but others reported that it was not.8,27,42,43 The most recent meta-analyses have shown that ER immobilization results in a lower recurrence rate and a higher rate of return to play.14,39
Double-Pulley Remplissage in Active-Duty Military Population With Off-Track Anterior Shoulder Instability Results in Improved Outcomes and Low Recurrence at Minimum 4-Year Follow-Up
2022, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :In 1989, Wheeler et al. published the first study on shoulder instability in this patient population and noted a 92% redislocation rate in shoulders treated nonoperatively following a traumatic dislocation.1 Over the past 30 years, authors have continued to demonstrate the effectiveness of shoulder stabilization surgery in preventing recurrent instability, especially in active-duty military patients.3,4,9,10,37-43 Despite the successes seen with arthroscopic stabilization, the recurrence rate never quite reached 0%.
The authors report that they have no conflicts of interest in the authorship and publication of this article.