Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2015; 6(4): 400-408
Published online May 18, 2015. doi: 10.5312/wjo.v6.i4.400
Surgical interventions for anterior shoulder instability in rugby players: A systematic review
Sanjeeve Sabharwal, Nirav K Patel, Anthony MJ Bull, Peter Reilly
Sanjeeve Sabharwal, Nirav K Patel, SpR Trauma and Orthopaedics, Imperial College NHS Trust, St Mary’s Hospital, London W2 1NY, United Kingdom
Anthony MJ Bull, Musculoskeletal Mechanics, Imperial College London, Imperial College London, London SW7 2AZ, United Kingdom
Peter Reilly, Imperial College NHS Trust, St Mary’s Hospital, London W2 1NY, United Kingdom
Author contributions: All authors contributed to this review manuscript; Sabharwal S was the lead author and performed the search, analyzed the results and was responsible for writing the manuscript; Patel NK was responsible for performing the search, analyzing the results, reviewing and editing the manuscript; Bull AMJ and Reilly P were responsible for designing the review, overseeing the review methodology and both edited and updated subsequent revisions of the initial manuscript.
Conflict-of-interest: All the authors have no conflicts of interests to declare.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Sanjeeve Sabharwal, MBBS, MRCS, MSc, SpR Trauma and Orthopaedics, Imperial College NHS Trust, St Mary’s Hospital, Ground Floor Salton House, South Wharf Road, London W2 1NY, United Kingdom.
Telephone: +44-07-939447204
Received: January 13, 2015
Peer-review started: January 18, 2015
First decision: February 7, 2015
Revised: February 21, 2015
Accepted: April 10, 2015
Article in press: April 12, 2015
Published online: May 18, 2015

AIM: To systematically evaluate the evidence-based literature on surgical treatment interventions for elite rugby players with anterior shoulder instability.

METHODS: We conducted a systematic review according to the PRISMA guidelines. A literature search was performed in PubMed, EMBASE and Google Scholar using the following search terms: “rugby” and “shoulder” in combination with “instability” or “dislocation”. All articles published from inception of the included data sources to January 1st 2014 that evaluated surgical treatment of elite rugby players with anterior shoulder instability were examined.

RESULTS: Only five studies were found that met the eligibility criteria. A total of 379 shoulders in 376 elite rugby union and league players were included. All the studies were retrospective cohort or case series studies. The mean Coleman Methodological Score for the 5 studies was 47.4 (poor). Owing to heterogeneity amongst the studies, quantitative synthesis was not possible, however a detailed qualitative synthesis is reported. The overall recurrence rate of instability after surgery was 8.7%, and the mean return to competitive play, where reported, was 13 mo.

CONCLUSION: Arthroscopic stabilization has been performed successfully in acute anterior instability and there is a preference for open Latarjet-type procedures when instability is associated with osseous defects.

Keywords: Shoulder, Instability, Dislocation, Rugby, Latarjet

Core tip: Arthroscopic stabilization can be performed successfully for acute anterior instability and an open Latarjet procedure is preferred where there is instability associated with an osseous defect. Interestingly, within the latter group a large proportion of patients do not return to competitive play following their surgery. The evidence base in this field is based on a limited number of studies which lack methodological rigor. As shoulder instability represents a serious musculoskeletal injury within competitive level rugby, there is a need for well-designed trials or sports medicine registries, to better inform orthopaedic surgeons on the management of this cohort of patients.