Multidirectional instability of the shoulder: A systematic review

Umile Giuseppe Longo, Giacomo Rizzello, Mattia Loppini, Joel Locher, Stefan Buchmann, Nicola Maffulli, Vincenzo Denaro

Research output: Contribution to journalReview articlepeer-review

117 Scopus citations

Abstract

Purpose To analyze outcomes of surgical and conservative treatment options for multidirectional instability (MDI). Methods A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. A comprehensive search of the PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar databases using various combinations of the keywords "shoulder," "multidirectional instability," "dislocation," "inferior instability," "capsulorrhaphy," "capsular plication," "capsular shift," "glenoid," "humeral head," "surgery," and "glenohumeral," over the years 1966 to 2014 was performed. Results Twenty-four articles describing patients with open capsular shift, arthroscopic treatment, and conservative or combined management in the setting of atraumatic MDI of the shoulder were included. A total of 861 shoulders in 790 patients was included. The median age was 24.3 years, ranging from 9 to 56 years. The dominant side was involved in 269 (58%) of 468 shoulders, whereas the nondominant side was involved in 199 (42%) shoulders. Patients were assessed at a median follow-up period of 4.2 years (ranging from 9 months to 16 years). Fifty-two of 253 (21%) patients undergoing physiotherapy required surgical intervention for MDI management, whereas the overall occurrence of redislocation was seen in 61 of 608 (10%) shoulders undergoing surgical procedures. The redislocation event occurred in 17 of 226 (7.5%) shoulders with open capsular shift management, in 21 of 268 (7.8%) shoulders with arthroscopic plication management, in 12 of 49 (24.5%) shoulders undergoing arthroscopic thermal shrinkage, and in 11 of 55 (22%) shoulders undergoing arthroscopic laser-assisted capsulorrhaphy. Conclusions Arthroscopic capsular plication and open capsular shift are the best surgical procedures for treatment of MDI after failure of rehabilitative management. Arthroscopic capsular plication shows results comparable to open capsular shift. Level of Evidence Level IV, systematic review of Level I to IV studies.

Original languageEnglish
Pages (from-to)2431-2443
Number of pages13
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume31
Issue number12
DOIs
StatePublished - 1 Dec 2015
Externally publishedYes

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