Bankart surgery is the most effective treatment for first-time anterior shoulder dislocation without significant bone loss – Systematic review and network meta-analysis

Introduction: The shoulder is the most commonly dislocated joint, with a recurrence rate of up to 100 % in the untreated young population. However, a clear and universally accepted treatment guideline is still missing. Our study aimed to provide an international literature review that could help find the most effective therapy. Methods: We comprehensively searched three databases (PubMed, Embase, and Cochrane), including 19 randomized controlled trials. Based on these, we conducted a network meta-analysis to examine the success rates of three different treatment methods after first-time acute anterior shoulder dislocation: fixation in internal rotation (IR imm), external rotation (ER imm), and arthroscopic Bankart (Art Bkrt) surgery. The main focus of our study was the safety and efficacy of the different therapies. The risk of bias was assessed using Rob2. Outcome measures were standardized mean difference (SMD) for continuous data and odds ratio (OR) for dichotomous data. Results: P score for redislocation was significantly higher in the arthroscopic Bankart group, reaching 0.9994 compared to the values of the external rotation and internal rotation groups (p = 0.3012, p = 0.1994, respectively). The same results were obtained for subluxation and residual feeling of instability, favoring arthroscopic Bankart repair against conservative treatment options. Conclusion: Arthroscopic Bankart surgery has the best success rate for first-time anterior shoulder dislocation without significant bone loss in terms of redislocation, subluxation, and instability. Conservative treatments provide inferior results. The translational potential of this article: To our knowledge, the most common international treatment methods for acute first-time anterior shoulder dislocations without significant bone loss have not yet been compared. Based on our study, the Bankart procedure is more effective than conservative treatment in preventing recurrence, especially after a 24-month follow-up period. In contrast, the results achieved with external rotation fixation are significantly weaker, while the effectiveness of internal rotation fixation is significantly lower than that of surgical intervention.