Arthroscopic Bankart Repair Versus Conservative Management for First-Time Traumatic Anterior Shoulder Instability: A Systematic Review and Meta-analysis

Abstract

Purpose: To perform a meta-analysis of the current evidence in the literature comparing arthroscopic Bankart repair versus conservative management for first-time anterior shoulder dislocation.

Methods: A literature search of the MEDLINE, Embase, and Cochrane Library databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Prospective studies comparing arthroscopic Bankart repair versus conservative management as treatment for first-time anterior shoulder dislocation were included. Recurrence, further treatment, and return to play were compared, with all statistical analysis performed using Review Manager, version 5.3. P < .05 was considered statistically significant.

Results: Ten prospective studies with 569 patients were included. Arthroscopic Bankart repair resulted in a lower rate of total recurrent instability (9.7% vs 67.4, I² = 0, P < .0001) and further surgical treatment for anterior shoulder instability (5.9% vs 46.7%, I² = 0, P < .0001). Additionally, arthroscopic Bankart repair resulted in a higher rate of return to play (92.8% vs 80.8%, I² = 0, P = .002).

Conclusions: Arthroscopic Bankart repair resulted in a 7-fold lower recurrence rate and a higher rate of return to play than conservative management. Thus, arthroscopic Bankart repair may be advisable to perform routinely in patients with first-time dislocation who participate in sports.

Level of evidence: Level II, systematic review of Level I and II studies.