A systematic review and meta-analysis of operative versus non-operative management for first time traumatic anterior shoulder dislocation in young adults

The most appropriate management following primary traumatic anterior shoulder dislocation in young adults is unclear. This systematic review and meta-analysis evaluated operative versus non-operative management. The primary outcome measure was re-dislocation rate, in contrast to the often reported ‘recurrent instability’, which includes subjective instability. Our review was prospectively registered with PROSPERO (CRD42022322600) and reported as per PRISMA guidelines. Selection criteria included mean age of participants between 15 and 25 and minimum follow-up of 1 year. 21 studies meet the inclusion criteria with 5142 patients included. The mean age of patients was 23, with 87% male. There was a median of 54 patients per study and a mean follow up of 46 months per study. The mean re-dislocation rate was 16.08% in the operative group and 24.84% in the non-operative group. In the subgroup meta-analysis, including only RCTs, comparing arthroscopic stabilisation vs non-operative there was an odds ratio of 0.09, strongly favouring intervention. This systematic review found the literature available supports surgical intervention in patients under the age of 25, in order to reduce re-dislocation. However, there is a lack of cost-effectiveness data to support these findings, and this should be an area of future research.