Key result
Arthroscopic repair significantly reduced anterior shoulder redislocation compared to conservative treatment, which had a 4.73-fold higher risk (RR 4.73; 95% CI 2.95-7.58; p<0.000).
Why the study?
The clinical efficacy of conservative treatment versus arthroscopic one-stage repair in patients with first-time anterior dislocation of the shoulder required systematic comparison.
Does arthroscopic repair reduce redislocation and revision surgery rates compared to conservative treatment in patients with first-time anterior shoulder dislocation?
Meta-Analysis
Does arthroscopic repair reduce redislocation and revision surgery rates compared to conservative treatment in patients with first-time anterior shoulder dislocation?
Relative Risk: 4.73 (95% CI 2.95–7.58)
p-value: p=<0.000
Early arthroscopic repair significantly reduces redislocation and revision surgery rates compared to conservative treatment in first-time anterior shoulder dislocation.
Supports early arthroscopic repair as first-line for first-time anterior shoulder dislocation; confirms Level 1 evidence favoring surgery over conservative care.
To systematically compare the clinical efficacy of conservative treatment and arthroscopic one-stage repair for patients with first-time anterior dislocation of the shoulder. A retrieval and systematic review of randomized controlled studies of primary anterior shoulder dislocation with conservative versus arthroscopic repair was conducted and further pooled analysis was performed to compare the overall difference in clinical outcomes, including redislocation and revision surgery rates, shoulder function scores and related complications. Preliminary meta-analysis showed that the risk of anterior shoulder redislocation was 4.73-fold higher in patients treated conservatively than those undergoing arthroscopic repair (RR:4.73 [2.95–7.58], p<0.000; I2=0%, p=0.920),and that the revision surgery rate was 5.91 times higher in the conservative group than in the arthroscopic repair group (RR:5.91 [2.82–12.39], p<0.000; I2=0%, p=0.560).Early arthroscopic repair can significantly reduce the redislocation and revision surgery rates and also improve the shoulder joint function score, without serious complications. However, it is necessary to recognize the subset of patients with a higher risk of redislocation in young patients through a high quality, blinded, prospective cohort study when early arthroscopic repair intervention in this subset of high-risk patients will be of significant clinical value.
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Lei et al. (2022) conducted a meta-analysis in first-time anterior dislocation of the shoulder. Arthroscopic repair vs. Conservative treatment was evaluated on anterior shoulder redislocation (RR 4.73, 95% CI 2.95-7.58, p=<0.000). Arthroscopic repair significantly reduced anterior shoulder redislocation compared to conservative treatment, which had a 4.73-fold higher risk (RR 4.73; 95% CI 2.95-7.58; p<0.000).
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