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Systematic review
Effectiveness of combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis
  1. Vaishnavi Chiddarwar1,
  2. Rutger M J de Zoete2,
  3. Cameron Dickson2,
  4. Timothy Lathlean3,4
  1. 1Texas Tech University Health Sciences Center, Lubbock, Texas, USA
  2. 2School of Allied Health Science and Practice, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
  3. 3Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
  4. 4South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
  1. Correspondence to Dr Timothy Lathlean, Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, SA 5005, Australia; timothy.lathlean{at}adelaide.edu.au

Abstract

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.

  • meta-analysis
  • shoulder
  • sporting injuries
  • sports medicine
  • rehabilitation

Data availability statement

No data are available as the data extracted for this systematic review and meta-analysis is available in the published literature.

http://dx.doi.org/10.1136/bjsports-2022-106422

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    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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    Footnotes

    • 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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.