Bankart pepair versus Bristow-Latarjet procedure for recurrent anterior instability of the shoulder: a meta-analysis

doi:10.3969/j.issn.2095-4344.3860

Abstract

Abstract: OBJECTIVE: Shoulder is the most unstable joint in the whole body, and the anterior instability caused by anterior dislocation of shoulder is the highest in all shoulder instabilities. Bankart pepair and Bristow-Latarjet procedure are both viable options for the treatment of recurrent anterior shoulder instability. However, since there is lack of systematic review of these two techniques, this article compared the clinical outcome of Bankart pepair and Bristow-Latarjet procedure in the treatment of recurrent anterior instability of shoulder by meta-analysis.
METHODS: Electronic searches were performed using PubMed, Ovid, Embase, Cochrane, CNKI, Wanfang, and VIP databases for retrospective case-control study or randomized controlled trial of anterior shoulder instability with Bankart repair and Bristow-Latarjet surgery. The data of binary variables (overall recurrence, revision surgery, and total complications), continuous variables (constant external rotation activity and Rowe score) and summary of the return to function findings after surgery were analyzed. Retrospective case-cohort studies used the NOS bias risk assessment standard recommended by Cochrane Collaborative Network to evaluate the quality of retrieved literatures, while randomized controlled trial study used the modified Jadad scale to evaluate the quality of literature. Literature screening, literature quality evaluation and data extraction were carried out independently by two researchers. Meta-analysis was conducted using RevMan 5.3 software.
RESULTS: (1) A total of 11 articles were included, containing 10 retrospective case-cohort studies and 1 randomized controlled trial study; research evidence is low-level. This study includes 1 308 patients, 190 cases of open Bankart repair, 583 cases of arthroscopic Bankart repair and 535 cases of open Bristow-Latarjet procedure. (2) Meta-analysis showed that compared with open or arthroscopic Bankart repair, the recurrence rate after Bristow-Latarjet procedure was lower (RR=3.64, 95%CI:1.79-7.39); Rowe score was higher (WMD=-4.00, 95%CI:-4.68 to -3.31, P < 0.000 01). (3) The total complication rate of open or arthroscopic Bankart repair was lower than Bristow-Latarjet procedure, but there was no significant difference between the two procedures (RR=0.57, 95%CI:0.26-1.26, P=0.16). (4) Though incidence of revision surgery (RR=1.42, 95%CI:0.82-2.46, P=0.21), limitation of external rotation (WMD=-2.43, 95%CI:-5.40-0.54, P=0.11), and postoperative recovery to preinjury working status or activity ability suggested that Bristow-Latarjet procedure was better than open or arthroscopic Bankart repair, but there was no significant difference (P > 0.05).
CONCLUSION: In terms of the recurrent rate and the ability recovery, Bristow-Latarjet procedure may be a better option compared with Bankart repair technique for the treatment of anterior instability of the shoulder, while the complication rate is relatively high. For professional athletes involved in collision or contact sports, Bristow-Latarjet surgery may be a better option for the treatment of anterior shoulder instability. Due to the limited quality of the inclusion studies, a host of randomized controlled trial studies should be conducted in the future to confirm this result.

Key words: joint, shoulder joint, recurrence, dislocation, recovery, function, randomized controlled trial, meta-analysis

CLC Number:

Wang Yanjiao, Wang Rui, Sun Luning. Bankart pepair versus Bristow-Latarjet procedure for recurrent anterior instability of the shoulder: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(21): 3423-3430.

Figures/Tables 11

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