Table 1

Summary of included studies

Author, year, countryInterventionControlN: recruited/FUFollow-up timeMean age of patientsMain outcome (primary outcome if defined)
First-time traumatic shoulder dislocation
Early surgery
(I) Kirkley et al  (1999)4 Canada
(II) Kirkley et al (2005)15 Canada
Arthroscopic LR3 weeks immobilisation(I) 40/38
(II) 40/31
(I) I: 31.7 (18.1–51.1)
C: 33.1 (21.8–54.2)
(II) 79 (51–102)
Intervention: 22.1*
Control: 22.75*
(I) RDR: I: 3/19 (16%)—C: 9/19 (47%) p=0.03
(II) Mean WOSI (%): I: 86%—C: 74.8%, NS
(I) Wintzell et al  (1999)7 Sweden
(II) Wintzell et al (1999)16 Sweden
Arthroscopic lavage1 week sling(I) 60/57
(II) 30/30
(I) 1 year
(II) 2 years
(I) I: 23.5 (±3.8)
C: 23.6 (±3.8)
(II) Total: 24 years
(I) RDR: I: 4/30 (13%)—C: 13/30 (43%), p=0.02
(II) RDR: I: 3/15 (20%)—C: 9/15 (60%)—p=0.03
Jakobsen et al (2007)3 DenmarkDA and open LRArthroscopic lavage76/752 years
10 years
I: 23 (15–39)
C: 20 (15–31)
RDR 2 years: I: 1/37 (3%)—C: 21/39 (54%), p=0.0011
RDR 10 years I: 3/36 (9%)—C: 24/39 (62%), p not reported
Robinson et al (2008)6 UK (Scotland)Arthroscopic LRArthroscopic lavage88/842 yearsI: 24.3 (±4.6)
C: 25.3 (±4.8)
RDR: I: 3/42 (7%)—C: 12/42 (38%), p=0.02
Arm position
Itoi et al (2007)43 JapanERI 3 weeksIRI 3 weeks198/15925.6 (24–30)I: 35 (12–90)
C: 37 (12–89)
RIR: I: 22/85 (26%)—C: 31/74 (42%), p=0.033
Finestone et al (2009)41 IsraelERI 4 weeksIRI 4 weeks51/51I: 35.8 (24–48)
C: 30.8 (24–47)
20.3RDR: I: 10/27 (37%)—C: 10/24 (42%), NS
Liavaag et al (2011)44 NorwayERI 3 weeksIRI 3 weeks188/18329.1 (24–54)26.8 (15.9– 40, ±7.1)RDR: I: 28/91 (31%)—C: 23/93 (25%), NS
RIR: I: 31/81 (38%)—C: 36/82 (42%), NS
Heidari et al (2014)42 IranERI 3 weeksIRI 3 weeks102/10224I: 36 (±7.8)
C: 35.43 (±10.0)
RIR: I: 2/51 (3.9%)—C: 17/51 (33.3%), p<0.001
Whelan et al (2014)45 CanadaERI 4 weeksIRI 4 weeks60/5025 (12–43)I: 23 (16–35)
C: 23 (14–34)
RDR: I: 6/27 (22%)—C: 8/25 (32%), NS
Use of restriction band
Itoi et al (2013)57 JapanC+I1: MRB 3 or I2: MRB 6 weeksERI 3 weeks109/90I1: 26.5, I2: 26.5
C: 25.5
30 (15–84)RDR: I1: 10/31 (32%)—I2: 10/30 (33%)—C: 8/29 (28%), NS
Chronic post-traumatic shoulder instability
Open or arthroscopic surgery
Sperber et al (2001)46 SwedenArthroscopic LROpen LR56/5624I: 25 (18–51)
C: 27.5 (19–45)
RIR: I: 7/30 (23%)—Control: 3/26 (12%), NS
Fabbriciani et al (2004)2 ItalyArthroscopic LRDA and open LR60/6024I: 24.5 (19–33)
C: 26.8 (21–30)
CS (SD) (difference from BL (SD)): I: 89.5 (±4.25) (23 (±5.89)) points—C: 86.7 (±6.07) (20.2 (±8.22)) points, NS
Archetti Netto et al (2012)5 BrazilArthroscopic LROpen LR50/4237.5 (20–56)I: 27.5 (±5.4)
C: 30.8 (±5.6)
DASH (range, SD): I: 2.65 (0–24, ±7.3)—C: 4.22 (0–21, ±5.8), p=0.031 (MCID is >10)91
Mohtadi et al (2014)47 CanadaOpen LRArthroscopic LR196/16224I: 27.8 (16–53.7, ±7.9)
C: 27.2 (16.5–59, ±9)
WOSI (95% CI) BL →FU: I: 41.7% (37.9–45.5) → 85.2% (80.5–89.8)C: 40.6% (36.9–44.3) → 81.9% (77.4–86.4), NS
Absorbable or non-absorbable implant materials (anchors)
Warme et al (1999)50 USAOpen LR, non-A SAOpen LR, bio-A SA38/4025 (17–45)22 (17–46)†Loss of ER (°): I: 3 (0–15)—C: 3 (0–10), NS
Tan et al (2006)49 UKArthroscopic LR, non-A SAArthroscopic LR, bio-A SA124/1242.6 (1.5–5) yearsI: 27 (18–45, ±7)
C: 28 (17–49, ±8)
OSIS (SD): BL → FU: I: 36 (±8) → 18 (±6)—C: 36 (±7) → 20 (±10), p not reported
Milano et al (2010)48 ItalyArthroscopic LR, non-A SAArthroscopic LR, bio-A SA78/7024.5 (22–29)I: 28 (16–46)
C: 28 (16–52)
DASH (range): I: 4.5 (0–27)—C: 7 (0–25), NS
Addition of posterior capsular plication
Castagna et al (2009)51 ItalyArthroscopic LR, bio-A SAI+posterior 2-anchor capsular plication40/402 yearsI: 29.1
C: 27.3
FF BL → FU: I: 169 (83–105) → 172.5 (155–180)—C: 177.8 (170–180) → 163.3 (140–175) p for change <0.001
Different absorbable implant materials
(I) Magnusson et al (2006)53 Sweden
(II) Elmlund et al (2009)54 Sweden
Arthroscopic LR PLLA tacksArthroscopic LR PGACP tacks40/35(I) I: 25 (24–34)
C: 26 (23–35)
(II) I: 80 (75–95)
C: 81 (64–96)
I: 26 (16–50)‡
C: 30 (15–45)‡
(I) Drill hole visibility: more visible in I, p<0.004
(II) Drill hole visibility: more visible in I, p<0.0001
Absorbable or non-absorbable suture materials
Monteiro et al (2008)55 BrazilArthroscopic LR bio-A SA+bio-A suturesArthroscopic LR bio-A SA+non-A sutures50/45I: 31.5 (24–45)
C: 30.9 (24–45)
23.5 (16–37)Rowe (range): I: 83.81 (35–100)—C: 79.58 (35–100), NS
Rehabilitation
Kim et al (2003)56 KoreaAcceleratedTraditional62/6231 (27–45, ±9)I: 29 (15–38, ±5.8)‡
C: 28 (18–39, ±5.6)‡
RDR: 0/62 (0%), subluxation rate: 0/62 (0%), NS
Anatomic versus non-anatomic surgical techniques
Salomonsson et al
(2009)52 Sweden
Open LR and capsular imbricationModified Putti-Platt procedure66/62143 (121–162, ±12.2)I: 29 (17–52)‡
C: 26 (16–63)‡
Rowe: I: 90, C: 90, NS
  • Follow-up times are tabulated as presented in the original publication as mean (range) in months unless noted otherwise. Mean age is presented as mean (range) or mean (±SD) or mean (range ±SD) in years unless noted otherwise. The point of recording participant age was not specified in the publication, unless marked otherwise (*at first dislocation, †at surgery, ‡preoperatively).

  • Bio-A, bio-absorbable; BL, base level; C, control; CS, constant score; DA, diagnostic arthroscopy; DASH, disabilities of the arm, shoulder and hand; ER, external rotation; ERI, external rotation immobilisation; FF, forward flexion (in degrees); FU, follow-up; I, intervention; IRI, internal rotation immobilisation; LR, labrum repair; MCID, minimal clinically important difference; MRB, motion restriction band; non-A, non-absorbable; NS, no statistically significant difference; OISS, Oxford Instability Shoulder Score; PGACP, polygluconate co-polymer; PLLA, polylactic acid; RDR, redislocation rate; RIR, recurrent instability rate; SA, suture anchor; WOSI, Western Ontario Shoulder Instability Index Score.