Arthroscopic Repair for Posterior Shoulder Instability Is Associated With Favorable Outcomes and High Return to Sport or Work: A Systematic Review and Meta-Analysis

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-04-01 DOI:10.1016/j.asmr.2024.101032

Antonio Cusano M.D. , Alexander J. Ment B.A. , Kevin A. Hao M.D. , Jayson Saleet B.A. , Patrick Nian B.A. , Emily Curry M.P.H. , Michael Groot M.S. , David Novikov M.D. , Hussein Abdul-Rassoul M.D. , Robert L. Parisien M.D. , Brett D. Owens M.D. , Xinning Li M.D.

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Abstract

Purpose

To assess clinical outcomes of primary arthroscopic repair for unilateral posterior shoulder instability (PSI) in all patients, to evaluate clinical outcomes in athletes, and to compare clinical outcomes between contact and overhead athletes.

Methods

A systematic review was performed using PRISMA Guidelines. Included studies reported on primary arthroscopic treatment of PSI with at least 1 year of follow-up. Studies were excluded if they were not in English, included revisions/open procedures or anterior/multidirectional instability, had fewer than 10 patients or no full text available, or were biomechanical analyses/descriptions of surgical technique. Primary outcomes were rates of return to sport (RTS), return to preinjury level (RTPL), recurrent instability, and revision surgery. Outcomes were evaluated in all patients and all athletes, with further subdivision for contact and overhead.

Results

Of the 1,504 screened studies, 30 met inclusion criteria (1,649 shoulders). Mean age at surgery was 23.3 years (range: 12.4–65 years), and mean follow-up was 35.5 months (range: 12–140.4 months). There were 1,051 males and 196 females. RTS rates were 91.7% among all patients and 90.9% in all athletes, with no statistical difference between contact and overhead athletes (92.8% vs 88.1%; P = .176). RTPL rates were 78.7% among all patients and 75.6% in all athletes, with no statistical difference between contact and overhead athletes (90.8% vs 62.3%; P = .072). Recurrent instability rates were 7.0% among all patients and 8.0% in all athletes, with no statistical difference between contact and overhead athletes (7.3% vs 7.4%; P = .981). Revision rates were 3.7% among all patients and 3.3% in all athletes, with no statistical difference between contact and overhead athletes (6.8% vs. 0%; P = 1).

Conclusion

Primary arthroscopic treatment of PSI is associated with favorable outcomes and high return to sport and work rates. Recurrent instability and pain were the most common reasons for revision.

Level of Evidence

Level IV, Systematic review and meta-analysis of Level II to IV studies.

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关节镜修复后肩不稳定与良好的预后和高的运动或工作恢复相关：一项系统回顾和荟萃分析

目的评估所有患者单侧后肩不稳（PSI）的初级关节镜修复的临床结果，评估运动员的临床结果，并比较接触式和头顶式运动员的临床结果。方法采用PRISMA指南进行系统评价。纳入的研究报告了原发性关节镜治疗PSI至少1年的随访。排除非英文研究，包括修订/开放手术或前路/多向不稳定，少于10例患者或没有全文，或生物力学分析/手术技术描述。主要结局是运动恢复率（RTS）、恢复到损伤前水平（RTPL）、复发性不稳定和翻修手术。对所有患者和运动员的结果进行评估，并进一步细分接触和头顶。结果在1504项筛选研究中，30项符合纳入标准（1649例）。平均手术年龄23.3岁（12.4 ~ 65岁），平均随访时间35.5个月（12 ~ 140.4个月）。其中男性1051人，女性196人。所有患者的RTS率为91.7%，所有运动员的RTS率为90.9%，接触和头顶运动员的RTS率无统计学差异(92.8% vs 88.1%；P = .176)。所有患者的RTPL率为78.7%，所有运动员的RTPL率为75.6%，接触和头顶运动员的RTPL率无统计学差异(90.8% vs 62.3%；P = .072)。复发不稳定率在所有患者中为7.0%，在所有运动员中为8.0%，接触和头顶运动员之间无统计学差异(7.3% vs 7.4%；P = .981)。所有患者的翻修率为3.7%，所有运动员的翻修率为3.3%，接触和头顶运动员的翻修率无统计学差异(6.8% vs 0%；P = 1)。结论关节镜下原发性PSI治疗预后良好，运动恢复率和工作恢复率高。复发性不稳定和疼痛是最常见的翻修原因。证据水平：IV级，II至IV级研究的系统回顾和荟萃分析。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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