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Return To Sport After Surgical Management Of Posterior Shoulder Instability: A Systematic Review And Meta-Analysis

Return To Sport After Surgical Management Of Posterior Shoulder Instability: A Systematic Review And Meta-Analysis

Kyle Gouveia, MD, CANADA Jeffrey Kay, MD, CANADA Muzammil Memon, MD, CANADA Nicole Simunovic, MSc, CANADA Asheesh Bedi, MD, UNITED STATES Olufemi R. Ayeni, MD, PhD, MSc, FRCSC, CANADA

McMaster University, Hamilton, Ontario, CANADA


2021 Congress   ePoster Presentation     Not yet rated

 

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Summary: Meta-analysis of return to sport rates following surgical management of posterior shoulder instability reveals a high overall rate of return to sport (88% [95% CI, 84%-92%]), as well as rate of return to sport at the pre-injury level (68% [95% CI, 60%-76%]).


Background

Posterior shoulder instability accounts for a small proportion of all shoulder instability, though it can affect athletes of all types; from contact to overhead athletes. Surgical treatment is quite successful in these patients; however the literature reports a wide range of rates of return to sport.

Purpose

The purpose of this systematic review was to determine the return to sport rates following surgical stabilization for posterior shoulder instability. It was hypothesized that patients would experience a high rate of return to sport.

Methods

The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until April 2020 and studies were screened by two reviewers independently and in duplicate for studies reporting rates of return to sport following surgical management of posterior shoulder instability. Demographic data as well as data on return to sport and functional outcomes were recorded. A meta-analysis of proportions was used to combine the rates of return to sport using a random effects model. A risk of bias assessment was performed for all included studies.

Results

Overall, 32 studies met inclusion criteria and comprised 1100 patients (1153 shoulders) with a mean age of 22.8 years (range 11-65) and a mean follow-up of 43.2 months (range 10-228). The pooled rate of return to any level of sport was 88% (95% CI, 84%-92%; I2=68.7%). In addition, the pooled rate of return to the preinjury level was 68% (95% CI, 60%-76%; I2=79%). Moreover, the pooled return to sport rate for contact athletes was 94% (95% CI, 90%-97%; I2=0%), while for throwing athletes it was 88% (95% CI, 83%-92%; I2= 0%).

Conclusion

Surgical management of posterior shoulder instability resulted in a high rate of return to sport, as well as significant pain reduction and functional improvement in most patients. However, only approximately two-thirds of athletes can return to their pre-injury level of sport.


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