Summary

Study investigates sex-based differences in outcomes post-surgery for shoulder instability. Meta-analysis of 14 studies found no significant disparities between males and females in recurrence, reoperation, and return to sport rates, as well as ASES and WOSI scores following surgery. The study suggests similar surgery efficacy between both sexes.

Abstract

Introduction/Purpose: Sex-based anatomic differences have been observed in patients with anterior shoulder instability. However, there are few and conflicting studies on sex-related variations in outcomes following surgery for shoulder instability. The purpose of this study was to examine sex-based disparities in outcomes following surgery for anterior shoulder instability.

Methods

A systematic search of electronic databases was completed using PRISMA guidelines to identify level I–III clinical studies on anterior shoulder instability that had been written between January 2003 and May 2023. Studies that evaluated outcomes following surgery for anterior shoulder instability in male and female patients were included. Systematic reviews, case reports, and case series were excluded. A meta-analysis was performed to examine the following sex-specific results: recurrence rate, reoperation rate, return to sport rate, the American Shoulder and Elbow Surgeons (ASES) score, and the Western Ontario Shoulder Instability (WOSI) index.

Results

A total of 7,028 studies were identified in the initial search, 14 of which met the inclusion criteria. A total of 1,262 patients were analyzed between the studies (932 males; 330 females). Instability recurrence, return to sport (RTS), reoperation rate, ASES scores, and WOSI scores were included in the meta-analysis. The meta-analysis demonstrated no significant difference in the rate of instability recurrence for males versus females following arthroscopic Bankart repair, open Bankart repair, and open Latarjet procedures (odds ratio [OR] = 1.05; 95% CI = 0.74, 1.50; P = .77). There was no significant difference between males and females in the rate of reoperation (OR = 0.84; 95% CI = 0.69, 1.02; P = .08) or RTS (OR = 1.09; 95% CI = 0.54, 2.22; I2 = 0%; P = .81). The pooled mean ASES score in female and male patients were 89.85 ± 16.73 SEM and 91.08 ± 13.59 SEM respectively. The pooled mean WOSI score in female and male patients were 87.26 ± 14.09 SEM and 81.325 ± 19.23 SEM respectively. Furthermore, there was no significant difference between males and females in reported ASES (mean difference [MD] = -1.20, CI = -4.28, 1.88; I2 = 0%; P = .45) or WOSI scores (MD = 4.94, CI = -0.31, 10.00; I2 = 0%; P = .06).

Conclusion

The rate of recurrence, return to sport, and reoperation rates were statistically similar between males and females following arthroscopic Bankart repair, open Bankart repair, and open Latarjet procedures. Male and female patients also displayed no significant difference in postoperative ASES and WOSI scores following these procedures. This study demonstrates that male and female patients have similar outcomes following surgery for anterior shoulder instability, as demonstrated by multiple parameters.