Surgical Versus Conservative Treatment Of Acute Glenohumeral Dislocations For Preventing Recurrent Dislocations: A Systematic Review

Abstract

PURPOSE: To perform a systematic review to determine the numbers needed to treat (NNT) and relative risk reduction (RRR) associated with arthroscopic surgical repair versus conservative therapy in reducing recurrence rates among patients with acute traumatic shoulder dislocations. METHODS: We searched MEDLINE, SPORT Discus, and CINAHL from inception to September 2008 using combinations of the terms shoulder, glenohumeral, instability, dislocation, acute, traumatic, rehabilitation, strengthening, surgery, surgical, repair, reconstruction, arthroscopic, and arthroscopy. Selected articles were from peer-reviewed journals written in English. All articles were studies that compared arthroscopic surgical repair versus conservative therapy for reducing recurrence rates among patients recovering from acute traumatic glenohumeral dislocations. Nine studies met the inclusion criteria and were independently rated by 2 reviewers using the Physiotherapy Evidence Database (PEDro) scale. PEDro scores ranged from 4 to 8 out of 10. The total number of subjects and the number of recurrent dislocations within each group were used to calculate NNT and RRR for each study. The results were also pooled across studies. The average follow-up time for the studies included in the pooled results was 25.4 months. RESULTS: All 9 studies clearly demonstrated that the arthroscopic surgical procedure was more effective than conservative treatment in reducing the risk of recurrence among acute traumatic glenohumeral dislocators. The pooled NNT to benefit was 1.8 (95% CI = 1.6 to 2.1), indicating that 2 individuals would need to be treated surgically, rather than conservatively, in order to prevent one recurrent glenohumeral dislocation. The pooled RRR for prevention of recurrent dislocation was 84.1% (95% CI = 75.0% to 89.8%) in favor of those who received surgical treatment versus conservative treatment. CONCLUSIONS: The use of arthroscopic surgical repair over conservative treatment in patients with acute traumatic glenohumeral dislocations is supported with a Strength of Recommendation Taxonomy level of evidence of 1 and a grade A recommendation.