Similar Rate of Return to Sport and Reoperation but Higher Rate of Recurrent Instability in Contact Versus Noncontact Athletes After Primary Arthroscopic Anterior Bankart Repair: A Systematic Review and Meta-analysis

Abstract

Background:

Anterior shoulder instability (ASI) is often seen in both contact and noncontact athletes, and the arthroscopic Bankart repair (ABR) procedure is among the most utilized procedures to treat patients with this condition. There is a lack of large studies comparing the return to sport (RTS), outcome, and recurrence rates after ABR in contact and noncontact athletes.

Purpose:

To understand the differences in postoperative RTS, outcomes, and complications in contact and noncontact athletes after primary ABR for ASI.

Study Design:

Systematic review and meta-analysis; Level of evidence, 4.

Methods:

A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies reported primary ABR without remplissage to treat ASI in athletes with a 1-year minimum follow-up. Random-effects meta-analysis was performed to compare outcomes.

Results:

Of the 1575 screened studies, 31 studies (2387 shoulders) were included. The mean age was 23.3 years (range, 13-50 years; SD, 2.97 years), 89% of the athletes were male, and the mean follow-up was 55.1 months (range, 12-107 months; SD, 22.8 months). Contact and noncontact athletes had similar rates of RTS (79% [95% CI, 63%-89%] and 91% [95% CI, 82%-96%], respectively; P = .079) and return to preinjury level (71% [95% CI, 56%-82%] and 79% [95% CI, 73%-85%], respectively; P = .201). Contact and noncontact athletes also demonstrated similar rates of revision surgery (6% [95% CI, 3%-13%] and 4% [95% CI, 3%-7%], respectively; P = .334). Contact athletes, however, exhibited a significantly higher rate of recurrent instability than noncontact athletes (17% [95% CI, 10%-27%] vs 8% [95% CI, 6%-12%]; P = .023).

Conclusion:

Compared with noncontact athletes, contact athletes demonstrate similar rates of RTS, return to preinjury level of play, and need for revision surgery but a higher rate of recurrent instability after primary ABR for ASI.