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Clin Shoulder Elbow > Volume 19(2); 2016 > Article
Clinics in Shoulder and Elbow 2016;19(2):110-116.
DOI: https://doi.org/10.5397/cise.2016.19.2.110    Published online June 30, 2016.
Arthroscopic Repair versus Non-operative Treatment of First-time Traumatic Anterior Shoulder Dislocations: A Numbers-needed-to-treat Analysis for Prevention of Recurrent Dislocations
Jihong Park, Nicole L Cosby
1Athletic Training Laboratory, Department of Sports Medicine, Kyung Hee University, Yongin, Korea. jihong.park@khu.ac.kr
2Point Loma Nazarene University, San Diego, CA, USA.
Received: 28 May 2015   • Revised: 4 January 2016   • Accepted: 20 March 2016
Abstract
BACKGROUND: Arthroscopic surgical repair is a better intervention than non-operative (conservative) treatment for patients with shoulder dislocations. This systematic review determined the numbers-needed-to-treat (NNT) and relative risk reduction (RRR) associated with arthroscopic surgical repair versus non-operative treatment in reducing recurrence rates among patients with first-time traumatic anterior shoulder dislocations.
METHODS
We searched Google Scholar, MEDLINE, SPORTDiscus, and CINAHL from inception in 2015. All articles had to compare arthroscopic surgical repair and non-operative treatment and be written in English. We used the total number of subjects and the number of recurrent dislocations within each treatment to calculate the NNT and RRR for each study and the pooled data.
RESULTS
Six articles were selected and all clearly demonstrated that the arthroscopic surgical repair was more effective than non-operative treatment in reducing the recurrence episodes. The pooled NNT was 1.76 (95% confidence interval [CI]=NNT to benefit 1.50-2.13) and the pooled RRR was 86.0% (95% CI=77.0%-92.0%) among individuals who underwent arthroscopic repair. The average follow-up time was 56 months.
CONCLUSIONS
A Strength of Recommendation Taxonomy level of evidence of 1 with a grade A recommendation supports the use of arthroscopic surgical repair over non-operative treatment in prevention of first-time traumatic anterior shoulder dislocations. We suggest that sports medicine practitioners consider the patients' age, occupation, and physical activity level when making a clinical decision.
Key Words: Glenohumeral; Conservative; Instability; Redislocation
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