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A Comprehensive Comparison and Evaluation of Surgical Techniques for Anterior Shoulder Instability: A Bayesian Network Meta-Analysis

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A Comprehensive Comparison and Evaluation of Surgical Techniques for Anterior Shoulder Instability: A Bayesian Network Meta-Analysis

Moin Khan, MD, MSc, FRCSC, CANADA Saad Masud, BSc, UNITED STATES David Momtaz, MPH, UNITED STATES Marcel Betsch , MD, GERMANY Filippo Migliorini, MD, MBA, PhD, GERMANY Abdullah Ghali, MD, UNITED STATES Kyle Gouveia, MD, CANADA Timothy Leroux, MD, MEd, FRCSC, CANADA Ryan M. Degen, MD, FRCSC, CANADA

McMaster University , Hamilton, ON, CANADA

2023 Congress ePoster Presentation 2023 Congress Not yet rated

Anatomic Location

Shoulder

Diagnosis / Condition

Instability

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.

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.

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A Comprehensive Comparison and Evaluation of Surgical Techniques for Anterior Shoulder Instability: A Bayesian Network Meta-Analysis

A Comprehensive Comparison and Evaluation of Surgical Techniques for Anterior Shoulder Instability: A Bayesian Network Meta-Analysis

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Conclusion

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A Comprehensive Comparison and Evaluation of Surgical Techniques for Anterior Shoulder Instability: A Bayesian Network Meta-Analysis

A Comprehensive Comparison and Evaluation of Surgical Techniques for Anterior Shoulder Instability: A Bayesian Network Meta-Analysis

Background

Purpose

Methods

Results

Conclusion

More 2023 ISAKOS Congress Content