Objective To investigate the effectiveness, risk of recurrence and return to activity (RTA) of surgery combined with exercise-based interventions (EBI) versus EBI alone after traumatic anterior shoulder dislocation (ASD).
Design Systematic review and meta-analysis.
Data sources Systematic literature search (MEDLINE, Web of Science, Scopus, Google Scholar).
Eligibility Studies focused on EBI or EBI as a part of postoperative care for adults with an ASD, written in English, and published after 1990. We excluded diagnostic, assessment-based studies on individuals experiencing recurrent shoulder dislocations, concomitant shoulder injury, animal or cadaveric studies. Primary outcomes were dislocation RTA. Secondary outcomes were self-reported outcome measures, strength and range of motion. Random-effects meta-analysis was used to estimate the effect of EBI (SMD; Hedges’ g, RR). The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence.
Results Sixty studies were included (n=3598); seven were meta-analysed (n=345). The mean age of participants in the included studies was 26.71±9.19 and 56% of those included were male. Of the 60 studies included in the systematic review, 29 were fair quality (48.3%), 15 studies were good quality (25%) and 16 studies were poor quality (26.7%), (k=0.66). Individuals who underwent EBI alone were 2.03 times more likely to experience recurrent instability than individuals who underwent EBI in conjunction with surgery (RR 2.03, 95% CI 1.03 to 3.97). Individuals who underwent EBI with surgery appeared 1.81 times more likely to RTA than those who underwent EBI alone, although results were not statistically significant (RR 1.81, 95% CI 0.96 to 3.43).
Conclusions Surgery combined with EBI is more effective in reducing the risk of recurrence and possibly increasing RTA than EBI alone after traumatic ASD.
- sporting injuries
- sports medicine
Data availability statement
No data are available as the data extracted for this systematic review and meta-analysis is available in the published literature.
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Twitter @DrRdeZoete, @TimLathlean
Contributors TL conceived and designed the research project. VC and TL searched and screened the studies. VC and RMJdZ carried out the risk of bias assessment. CD and TL carried out the data extraction. TL analysed the data and interpreted the results of the analysis, over successive revisions and is responsible for the overall content as the guarantor. All authors drafted the manuscript and assisted in the interpretation of the data. All authors critically reviewed the manuscript, provided significant input to the initial submission and subsequent revisions and approved the final version.
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.
Provenance and peer review Not commissioned; externally peer reviewed.
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