Published online May 18, 2015. doi: 10.5312/wjo.v6.i4.400
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.
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.