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Surgical stabilization of pediatric anterior shoulder instability yields high recurrence rates: a systematic review

  • SHOULDER
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this systematic review was to assess the surgical techniques, indications outcomes and complications for pediatric patients (≤ 19 years old) undergoing shoulder stabilization procedures for anterior shoulder instability.

Methods

The electronic databases MEDLINE, EMBASE, CINAHL, and Web of Science were searched from data inception to March 14, 2019 for articles addressing surgery for pediatric patients with anterior shoulder instability. The Methodological Index for Non-randomized Studies (MINORS) tool was used to assess the quality of included studies.

Results

Overall 24 studies, with a total of 688 patients (696 shoulders) and a mean age of 16.6 ± 2.5 years met inclusion criteria. Mean follow-up was 49 ± 26 months. The majority (59%) of studies only offered shoulder stabilization procedures to patients with more than one shoulder dislocation, however, three studies reported operating on pediatric patients after first time dislocations. Of the included patients 525 had arthroscopic Bankart repair (78%), 75 had open Bankart repair (11%), 34 had modified Bristow (5%), and 26 had Latarjet (4%) procedures. The overall complication rate was 26%. Patients undergoing arthroscopic Bankart repair experienced the highest recurrence rate of 24%. There were no significant differences in recurrent instability (n.s.) or loss of external rotation (n.s.) in pediatric patients treated with arthroscopic Bankart repair compared to open Latarjet. Patients had a 95% rate of return to sport at any level (i.e. preinjury level or any level of play) postoperatively (95%).

Conclusions

Pediatric patients are at high risk of recurrent instability after surgical stabilization. The majority of pediatric patients with anterior shoulder instability were treated with arthroscopic Bankart repair. Most studies recommend surgical stabilization only after more than one dislocation. However, given the high rates of recurrence with non-operative management, it may be reasonable to perform surgery at a first-time dislocation, particularly in those with other risk factors for recurrence. With the current evidence and limited sample sizes, it is difficult to directly compare the surgical interventions and their post-operative efficacy (i.e. re-dislocation rates or range of motion). There was an overall high rate of return to sport after surgical stabilization at final follow-up.

Level of evidence

IV.

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Abbreviations

ISRCTN:

International Standard Registered Clinical/Social Study Number

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

MINORS:

Methodological Index for Non-Randomized Studies

CI:

Confidence interval

ICC:

Intraclass correlation coefficient

MRI:

Magnetic Resonance Imaging

MRA:

Magnetic Resonance Arthrography

ASES:

American Shoulder and Elbow Surgeons

SANE:

Single Assessment Numerical Evaluation

SF-12:

Short Form Health Survey

WOSI:

Western Ontario Shoulder Instability Index

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Funding

No funding was received for the implementation of this study.

Author information

Authors and Affiliations

  1. Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Ajaykumar Shanmugaraj, Mohamed Sarraj, Chetan Gohal, Nolan S. Horner, Nicole Simunovic & Olufemi R. Ayeni

  2. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    Darren Chai

  3. Roth McFarlane Hand and Upper Limb Center, St Joseph’s Health Care, London, ON, Canada

    George S. Athwal

  4. McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada

    Olufemi R. Ayeni

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  1. Ajaykumar Shanmugaraj
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  2. Darren Chai
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  3. Mohamed Sarraj
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  4. Chetan Gohal
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All authors contributed substantially to conception and design, or acquisition of data, or analysis and interpretation of data; drafted the article or revised it critically for important intellectual content; provided the final approval of the version to be published; and agreed to act as guarantor of the work (ensuring that questions related to any part of the work are appropriately investigated and resolved).

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Correspondence to Olufemi R. Ayeni.

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ORA is an educational consultant for the Speaker’s Bureau of Conmed.

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This review did not involve primary data collection from patients.

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Shanmugaraj, A., Chai, D., Sarraj, M. et al. Surgical stabilization of pediatric anterior shoulder instability yields high recurrence rates: a systematic review. Knee Surg Sports Traumatol Arthrosc 29, 192–201 (2021). https://doi.org/10.1007/s00167-020-05913-w

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