Recurrence, Return to Sport, and Reoperation Rates Appear Similar Between Males and Females After Surgery for Anterior Shoulder Instability: Future Research Requires Disaggregation by Sex.

Abstract

Purpose: To evaluate sex-based disparities in outcomes following surgery for anterior shoulder instability and to assess the quality of the current literature on this topic.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a June 2023 database search (PubMed, Web of Science, Embase, Cinahl) identified Level I to III clinical studies on anterior shoulder instability (January 2003 to May 2023). Eligible studies included male and female outcomes after anterior shoulder stabilization. Systematic reviews, case reports, and case series were excluded. A meta-analysis examined sex-specific results: recurrence, reoperation, return to sport, American Shoulder and Elbow Surgeons (ASES) score, and Western Ontario Shoulder Instability (WOSI) index.

Results: The initial search identified 7,028 studies, with 14 meeting inclusion criteria, totaling 1,262 patients (73.9% male, 26.1% female). Of the studies, 53% were excluded due to failure to disaggregate by sex. The meta-analysis found comparable outcomes by sex for recurrence (odds ratio [OR] = 1.05; 95% confidence interval [CI], 0.74-1.50; P = .77), reoperation rate (OR = 0.84; 95% CI, 0.69-1.02; P = .08), or return to sport (OR = 1.09; 95% CI, 0.54-2.22; P = .81) after arthroscopic Bankart, open Bankart, and open Latarjet procedures. Mean ASES scores were 91.08 ± 13.59 standard error of the mean (SEM) for males and 89.85 ± 16.73 SEM for females, while WOSI scores were 81.32 ± 19.23 SEM and 87.26 ± 14.09 SEM, respectively. Comparable outcomes were found in ASES (mean difference = -1.20; 95% CI, -4.28 to 1.88; P = .45) or WOSI scores (mean difference = 4.94; 95% CI, -0.31 to 10.00; P = .06).

Conclusions: Recurrence, return to sport, and reoperation rates were similar between males and females after arthroscopic Bankart, open Bankart, and open Latarjet procedures. Comparable outcomes were found in postoperative ASES and WOSI scores between sexes. Most relevant studies were excluded due to lack of disaggregation by sex, limiting the certainty of the conclusion and suggesting an opportunity to improve future research.

Level of evidence: Level III, systematic review of Level I and III studies.