TREATMENT AFTER TRAUMATIC SHOULDER DISLOCATION: A SYSTEMATIC REVIEW WITH A NETWORK META-ANALYSIS

BACKGROUND & OBJECTIVE

Traumatic shoulder dislocation commonly occurs from a high-energy trauma in games or training, or from a fall on an outstretched arm. Athletes involved in contact/overhead sports and males are at higher risk of sustaining these injuries. The risk of recurrence is highest during the first two years following the first episode of traumatic shoulder dislocation. This systematic review aimed to determine which treatment method helps to reduce the incidence of chronic shoulder instability following a first-time traumatic shoulder dislocation and to guide clinicians on how to best treat patients with chronic post-traumatic shoulder instability.

METHODS

Thirteen electronic databases and reference lists of included studies were searched for data without any limitations on language or publication date. Included studies were randomized control trials (RCTs) that compared treatments after first-episode of traumatic shoulder dislocation or chronic post-traumatic shoulder instability, and that included outcomes related to shoulder instability, function and quality of life (QOL). Data extraction was conducted for outcome measures through all follow-up phases. Risk of bias was assessed according to Cochrane Back review group guidelines. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to ascertain the quality of evidence. A meta-analysis and network meta-analysis were conducted.

Shared decision-making between the clinician and patient should be considered in the context of the patient's functional requirements and level of sports participation.

RESULTS

25 studies were included in this systematic review. 12 studies were related to first-time traumatic shoulder dislocation and 13 studies were on chronic post-traumatic shoulder instability. Mean participant age ranged between 20.3 to 36 years and the mean follow-up duration

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