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Systematic review
High rate of return to sport in adolescent athletes following anterior shoulder stabilisation: a systematic review
  1. Connor S Kasik1,
  2. Michael R Rosen1,
  3. Michael G Saper2,
  4. Robert L Zondervan3
  1. 1Department of Orthopaedic Surgery, McLaren Greater Lansing, Lansing, Michigan, USA
  2. 2Department of Orthopedics and Sports Medicine, Seattle Children’s, Seattle, Washington, USA
  3. 3College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
  1. Correspondence to Dr Connor S Kasik, Department of Orthopaedic Surgery, McLaren Greater Lansing, Lansing, MI 48910, USA; connorkasik{at}gmail.com

Abstract

Importance Traumatic anterior shoulder instability remains common for the adolescent athletes.

Aim or objective To perform a systematic review on the outcomes and return to sport (RTS) following Bankart repair in adolescent athletes.

Evidence review A systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was conducted of studies reporting outcomes following open and/or arthroscopic Bankart repair using modern suture anchors following traumatic anterior shoulder dislocations in adolescent patients (ages 10–19 years). Quality assessment was evaluated with ROBINS-I and MINORS instruments. The outcomes analysed included RTS, timetable to unrestricted activity, recurrent instability and revision surgery.

Findings This systematic review identified 11 studies comprising 461 adolescent athletes with a mean age of 15.7 years (range, 11–19 years) and an average follow-up of 48.8 months (range, 22–85.2 months). A total of 392 patients (400 shoulders) underwent arthroscopic Bankart repair, while the remaining 69 patients (69 shoulders) underwent an open procedure. The average MINORS score was 9.6 for non-comparative studies and 17 for comparative studies. ROBINS-I revealed six studies to have a moderate risk of bias, while the remaining five studies presented serious risk of bias. There was an overall 81.5% rate of RTS to preinjury levels of athletic competition at an average of 5.3 months following Bankart repair for traumatic anterior shoulder instability. The overall total mean incidence of recurrent instability was 18.5%, while the mean incidence of revision surgery was 12.1%. Contact athletes had a 31.1% and 13% rate of recurrence and revision surgery, respectively. In comparison, collision athletes were shown to have a 10.4% and 1.4% incidence of recurrent instability and revision surgery, respectively.

Conclusions and relevance Adolescent athletes who undergo Bankart repair for traumatic anterior shoulder instability have an 81.5% rate of RTS to preinjury levels of play at an average of 5 months following surgery. The overall total mean incidence of recurrent instability in the adolescent population is 18.5%, while the mean incidence of revision surgery is 12.1%. The results of anterior shoulder stabilisation in contact athletes is much less predictable, with higher reported rates of recurrent instability and revision surgery.

Level of evidence Level IV.

  • shoulder
  • dislocation
  • instability
  • arthroscopy
  • outcome studies

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Footnotes

  • Contributors CSK and MGS conceived the study. CSK and MRR carried out the search and screening process. MRR and RLZ carried out the assessment of study quality. CSK and MRR extracted the data. CSK drafted the manuscript. CSK and MGS edited the manuscript. MGS provided key expert input and editing throughout the process. RLZ provided key expert feedback on methodological and statistical aspects. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The corresponding author will share unpublished data on request, subject to various conditions.

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