Abstract：
BACKGROUND: First-time traumatic anterior shoulder dislocation (FASD) is a common trauma associated with shoulder dysfunction. Although several randomized controlled trials have compared conservative and surgical treatments for FASD, the comparative efficacy of these treatments is poorly understood. In this network meta-analysis (NMA), we compared the available evidence on the efficacy of various interventions in patients with FASD.
METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases in March 2023. This NMA included randomized controlled trials comparing conservative and surgical treatments for FASD, including arthroscopic Bankart repair, arthroscopic lavage, external rotation (ER) immobilization, and internal rotation (IR) immobilization. The primary outcomes were redislocation rates, Western Ontario Shoulder Instability Index (WOSI) scores, and adverse events (AEs). We conducted random-effects NMA within the frequentist framework. To rank the treatments, the Surface Under the Cumulative Ranking curve was calculated using a Bayesian framework. We evaluated confidence in each outcome using the CINeMA tool.
RESULTS: Of the 2999 reviewed studies, 15 were included and analyzed. Regarding the primary outcomes, arthroscopic Bankart repair likely results in a large reduction in redislocation rates compared to IR immobilization (risk ratio [RR], 0.15; 95% confidence interval [CI], 0.07-0.33). Both arthroscopic lavage (RR, 0.47; 95% CI, 0.20-1.11) and ER immobilization (RR 0.70; 95% CI, 0.50-1.00) may reduce the redislocation rates slightly compared with IR immobilization. According to these results, arthroscopic Bankart repair ranked first in terms of reducing the redislocation rate, followed by arthroscopic lavage, ER and IR immobilization. Regarding the WOSI score, no substantial differences were observed in the WOSI scores among the four treatments. AEs showed that ER immobilization tended to cause greater shoulder stiffness than IR immobilization, and postoperative erythema, swelling, and adhesive capsulitis were observed after arthroscopic Bankart repair and lavage. However, a meta-analysis was not performed because the definitions of AEs differed between the studies.
CONCLUSIONS: Arthroscopic Bankart repair showed a significant effect in reducing the redislocation rate compared to IR immobilization. Although both arthroscopic lavage and ER immobilization seemed to be effective in reducing the redislocation rates, it was not statistically significant. Moreover, these four treatments may result in little to no difference in disease-specific quality of life and there is no clear evidence of AEs.
METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases in March 2023. This NMA included randomized controlled trials comparing conservative and surgical treatments for FASD, including arthroscopic Bankart repair, arthroscopic lavage, external rotation (ER) immobilization, and internal rotation (IR) immobilization. The primary outcomes were redislocation rates, Western Ontario Shoulder Instability Index (WOSI) scores, and adverse events (AEs). We conducted random-effects NMA within the frequentist framework. To rank the treatments, the Surface Under the Cumulative Ranking curve was calculated using a Bayesian framework. We evaluated confidence in each outcome using the CINeMA tool.
RESULTS: Of the 2999 reviewed studies, 15 were included and analyzed. Regarding the primary outcomes, arthroscopic Bankart repair likely results in a large reduction in redislocation rates compared to IR immobilization (risk ratio [RR], 0.15; 95% confidence interval [CI], 0.07-0.33). Both arthroscopic lavage (RR, 0.47; 95% CI, 0.20-1.11) and ER immobilization (RR 0.70; 95% CI, 0.50-1.00) may reduce the redislocation rates slightly compared with IR immobilization. According to these results, arthroscopic Bankart repair ranked first in terms of reducing the redislocation rate, followed by arthroscopic lavage, ER and IR immobilization. Regarding the WOSI score, no substantial differences were observed in the WOSI scores among the four treatments. AEs showed that ER immobilization tended to cause greater shoulder stiffness than IR immobilization, and postoperative erythema, swelling, and adhesive capsulitis were observed after arthroscopic Bankart repair and lavage. However, a meta-analysis was not performed because the definitions of AEs differed between the studies.
CONCLUSIONS: Arthroscopic Bankart repair showed a significant effect in reducing the redislocation rate compared to IR immobilization. Although both arthroscopic lavage and ER immobilization seemed to be effective in reducing the redislocation rates, it was not statistically significant. Moreover, these four treatments may result in little to no difference in disease-specific quality of life and there is no clear evidence of AEs.
摘要：
背景：首次创伤性肩关节前脱位（FASD）是与肩关节功能障碍相关的常见创伤。尽管一些随机对照试验（RCT）比较了FASD的保守治疗和手术治疗，对这些治疗的疗效比较了解甚少。在这个网络荟萃分析(NMA)中，我们比较了各种干预措施对FASD患者疗效的现有证据.
方法：我们搜索了Cochrane中央对照试验登记册，MEDLINE,和EMBASE数据库在2023年3月。该NMA包括比较FASD的保守和手术治疗的RCT，包括关节镜Bankart修复术,关节镜灌洗,外旋(ER)固定,和内旋转（IR）固定。主要结果是再脱位率，西安大略省肩关节不稳定指数（WOSI）评分，和不良事件（AE）。我们在频率论框架内进行了随机效应NMA。对治疗进行排名，使用贝叶斯框架计算累积排序曲线下的曲面。我们使用CINeMA工具评估了每个结果的信心。
结果：在2,999项综述研究中，15个被纳入并分析。关于主要结果，与IR固定相比，关节镜Bankart修复可能导致再脱位率大大降低(风险比[RR]，0.15；95%置信区间[CI]，0.07-0.33）。两种关节镜灌洗（RR，与IR固定相比，0.47;95％CI，0.20-1.11）和ER固定（RR0.70;95％CI，0.50-1.00）可能会稍微降低再脱位率。根据这些结果,关节镜Bankart修复术在降低再脱位率方面排名第一，然后进行关节镜灌洗,ER和IR固定。关于WOSI分数，4种治疗方法的WOSI评分没有实质性差异.AE显示ER固定比IR固定倾向于引起更大的肩关节僵硬，术后出现红斑,肿胀,关节镜下Bankart修复和灌洗后观察到粘连性囊炎。然而,没有进行荟萃分析,因为研究之间的AE定义不同.
结论：关节镜Bankart修复与IR固定相比，在降低再脱位率方面具有显著作用。虽然关节镜灌洗和ER固定似乎都能有效降低再脱位率，没有统计学意义。此外，这四种治疗方法可能导致疾病特异性生活质量几乎没有差异，没有明确的AE证据。
方法：我们搜索了Cochrane中央对照试验登记册，MEDLINE,和EMBASE数据库在2023年3月。该NMA包括比较FASD的保守和手术治疗的RCT，包括关节镜Bankart修复术,关节镜灌洗,外旋(ER)固定,和内旋转（IR）固定。主要结果是再脱位率，西安大略省肩关节不稳定指数（WOSI）评分，和不良事件（AE）。我们在频率论框架内进行了随机效应NMA。对治疗进行排名，使用贝叶斯框架计算累积排序曲线下的曲面。我们使用CINeMA工具评估了每个结果的信心。
结果：在2,999项综述研究中，15个被纳入并分析。关于主要结果，与IR固定相比，关节镜Bankart修复可能导致再脱位率大大降低(风险比[RR]，0.15；95%置信区间[CI]，0.07-0.33）。两种关节镜灌洗（RR，与IR固定相比，0.47;95％CI，0.20-1.11）和ER固定（RR0.70;95％CI，0.50-1.00）可能会稍微降低再脱位率。根据这些结果,关节镜Bankart修复术在降低再脱位率方面排名第一，然后进行关节镜灌洗,ER和IR固定。关于WOSI分数，4种治疗方法的WOSI评分没有实质性差异.AE显示ER固定比IR固定倾向于引起更大的肩关节僵硬，术后出现红斑,肿胀,关节镜下Bankart修复和灌洗后观察到粘连性囊炎。然而,没有进行荟萃分析,因为研究之间的AE定义不同.
结论：关节镜Bankart修复与IR固定相比，在降低再脱位率方面具有显著作用。虽然关节镜灌洗和ER固定似乎都能有效降低再脱位率，没有统计学意义。此外，这四种治疗方法可能导致疾病特异性生活质量几乎没有差异，没有明确的AE证据。
