Abstract
PurposeThe extent of shoulder instability and the indication for surgery may be determined by the prevalence or size of associated lesions. However, a varying prevalence is reported and the actual values are therefore unclear. In addition, it is unclear whether these lesions are present after the first dislocation and whether or not these lesions increase in size after recurrence. The aim of this systematic review was (1) to determine the prevalence of lesions associated with traumatic anterior shoulder dislocations, (2) to determine if the prevalence is higher following recurrent dislocations compared to first-time dislocations and (3) to determine if the prevalence is higher following complete dislocations compared to subluxations.MethodsPubMed, EMBASE, Cochrane and Web of Science were searched. Studies examining shoulders after traumatic anterior dislocations during arthroscopy or with MRI/MRA or CT published after 1999 were included. A total of 22 studies (1920 shoulders) were included.ResultsThe proportion of Hill–Sachs and Bankart lesions was higher in recurrent dislocations (85%; 66%) compared to first-time dislocations (71%; 59%) and this was statistically significant (P < 0.01; P = 0.05). No significant difference between recurrent and first-time dislocations was observed for SLAP lesions, rotator-cuff tears, bony Bankart lesions, HAGL lesions and ALPSA lesions. The proportion of Hill–Sachs lesions was significantly higher in complete dislocations (82%) compared to subluxations (54%; P < 0.01).ConclusionHigher proportions of Hill–Sachs and Bankart were observed in recurrent dislocations compared to first-time dislocations. No difference was observed for bony Bankart, HAGL, SLAP, rotator-cuff tear and ALPSA. Especially when a Hill–Sachs or Bankart is present after first-time dislocation, early surgical stabilization may need to be considered as other lesions may not be expected after recurrence and to limit lesion growth. However, results should be interpreted with caution due to substantial heterogeneity and large variance.Level of evidenceIV.
Highlights
Anterior shoulder dislocations commonly occur following a fall or direct impact to the shoulder at home or during sports/recreation activities, reporting an incidence of1 3 Vol.:(0123456789)Knee Surgery, Sports Traumatology, Arthroscopy23.9 per 100,000 person-years and making up 45% of all dislocations [1,2,3]
The most important finding of the present study was that Hill–Sachs and Bankart lesions were found in higher proportions in recurrent dislocations compared to first-time dislocations
Results should be interpreted with caution due to the large range in prevalence; heterogeneity found in the Hill–Sachs, Humeral Avulsion of the Glenohumeral Ligament (HAGL) and Anterior Labral Periosteal Sleeve Avulsion (ALPSA) analyses; and limited amount of studies reporting on capsular lesions
Summary
Anterior shoulder dislocations commonly occur following a fall or direct impact to the shoulder at home or during sports/recreation activities, reporting an incidence of1 3 Vol.:(0123456789)Knee Surgery, Sports Traumatology, Arthroscopy23.9 per 100,000 person-years and making up 45% of all dislocations [1,2,3]. Traumatic anterior shoulder dislocations are often accompanied by lesions of the soft-tissue and bony structures in and around the glenohumeral joint [5]. A lack in epidemiological knowledge is problematic because the optimal management can vary between lesions. Some lesions are more likely related to these outcomes than others, such as bony lesions, which are thought to be a risk factor for failure of conservative management and after soft-tissue stabilization [21, 22]. This makes the presence and size of bony lesions important for surgical decision-making. Epidemiological knowledge of associated lesions may allow professionals to anticipate on these lesions and assist in deciding on the optimal management [23,24,25,26,27]
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