Bony reconstruction after failed labral repair is associated with higher recurrence rates compared to primary bony reconstruction: a systematic review and meta-analysis of 1319 shoulders in studies with a minimum of 2-year follow-up

Theodore P van Iersel; Sanne H van Spanning; Lukas P E Verweij; Simone Priester-Vink; Derek F P van Deurzen; Michel P J van den Bekerom

doi:10.1016/j.jse.2022.02.044

Bony reconstruction after failed labral repair is associated with higher recurrence rates compared to primary bony reconstruction: a systematic review and meta-analysis of 1319 shoulders in studies with a minimum of 2-year follow-up

J Shoulder Elbow Surg. 2022 Sep;31(9):1982-1991. doi: 10.1016/j.jse.2022.02.044. Epub 2022 Apr 14.

Authors

Theodore P van Iersel¹, Sanne H van Spanning², Lukas P E Verweij³, Simone Priester-Vink⁴, Derek F P van Deurzen⁵, Michel P J van den Bekerom⁶

Affiliations

¹ Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands. Electronic address: t.vaniersel@olvg.nl.
² Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.
³ Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands.
⁴ Department of Research and Epidemiology, OLVG, Amsterdam, the Netherlands.
⁵ Trauma Unit & Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.
⁶ Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.

PMID: 35430365
DOI: 10.1016/j.jse.2022.02.044

Abstract

Background: There is uncertainty with regard to the optimal revision procedure after failed labral repair for anterior shoulder instability. An overview of outcomes of these procedures with quantitative analysis is not available in literature. The aim of this review is (1) to compare recurrence rates after revision labral repair (RLR) and revision bony reconstruction (RBR), both following failed labral repair. In addition, (2) recurrence rates after RBR following failed labral repair and primary bony reconstruction (PBR) are compared to determine if a previous failed labral repair influences the outcomes of the bony reconstruction.

Methods: Randomized controlled trials and cohort studies with a minimum follow-up of 2 years and reporting recurrence rates of (1) RBR following failed labral repair and PBR and/or (2) RLR following failed labral repair and RBR following failed labral repair were identified by searching PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, and Web of Science/Clarivate Analytics.

Results: Thirteen studies met the inclusion criteria and comprised 1319 shoulders. Meta-analyses showed that RBR has a significantly higher recurrence rate than PBR (risk ratio [RR] 0.51, P < .008) but found no significant difference in the recurrence rates for RLR and RBR (RR 1.40, P < .49). Also, no significant differences were found between PBR and RBR in return to sport (RR 1.07, P < .41), revision surgery (RR 0.8, P < .44), and complications (RR 0.84, P < .53). Lastly, no significant differences between RLR and RBR for revision surgery (RR 3.33, P < .19) were found.

Conclusion: The findings of this meta-analyses show that (1) RBR does not demonstrate a significant difference in recurrence rates compared with RLR and that (2) RBR has a significantly higher recurrence rate than PBR.

Keywords: Bankart; Latarjet; Shoulder instability; bony reconstruction; labral repair; primary surgery; recurrence; revision surgery.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Arthroscopy / methods
Follow-Up Studies
Humans
Joint Instability* / etiology
Recurrence
Retrospective Studies
Shoulder
Shoulder Dislocation* / surgery
Shoulder Joint* / surgery