Surgical interventions for anterior shoulder instability in rugby players: A systematic review

Table 1 Modified Coleman Methodology Scoring system used to assess methodological quality of the studies included in this review

Only one score to be given for each of 7 sections
Study size	< 20	0
	20-50	4
	51-100	7
	> 100	10
Mean follow up	< 12 mo	0
	12-36 mo	4
	37-60 mo	7
	> 61 mo	10
Surgical or conservative approach	Different approach used and outcome no reported separately	0
	Different approaches used and outcome reported separately	7
	Single approach used	10
Type of study	Retrospective cohort	0
	Prospective cohort	10
	Randomised controlled trial	15
Description of indications/diagnosis	Described without % specified	0
	Described with % specified	5
Description of surgical or conservative technique	Inadequate (not stated, unclear)	0
	Fair (technique only stated)	5
	Adequate (technique stated, details of surgical or conservative procedure given)	10
Description of postoperative rehabilitation	Described	5
	Not described	0
Scores may be given for each option in each of the 3 sections if applicable
Outcome criteria	Outcome measures clearly defined	2
	Timing of outcome assessment clearly stated	2
	Use of outcome criteria that has reported reliability	3
	General heath measure included	3
Procedure of assessing outcomes	Participants recruited	5
	Investigator independent of surgeon	4
	Written assessment	3
	Completion of assessment by patients themselves with minimal investigator assistance	3
Description of subject selection	Selection criteria reported and unbiased	5
	Recruitment rate reported > 90%	5
	≤ 90%	0

Table 2 Summary table on each study’s demographics

Ref.	Journal	Level ofevidence	Country	No. of players (shoulders)	Type ofinstability	Osseous lesion(s)
Neyton et al[23]	Journal of shoulder and elbow surgery	IV	France	34 (37)	Recurrent, anterior	Bony Bankart 18/37, Hills-Sachs 25/37
Bonnevialle et al[21]	Rev Chir Orthop Reparatrice Appar Mot	IV	France	31	Recurrent, anterior	None
Larrain et al[26]	Arthroscopy	IV	Argentina	198	Acute anterior instability (40), recurrent anterior instability (158)	Large bony defect: Bony Bankart 16/198, Hills-Sachs 2/198, Combined 9/198
						Small bony defect: Bony Bankart < 25% 36/198, Hills Sachs < 1/4 172/198
Goldberg et al[24]	British Journal of Sports Medicine	IV	Australia	6	Acute anterior instability (1/6), chronic recurrent (5/6), all patients had rotator cuff tears	1/6 Bony bankart
Burkhart et al[25]	Arthroscopy	IV	United States/South Africa	96	Anterior instability acute and recurrent	8/96 Bony Bankart and Hill-Sachs

Table 3 Summary table on mean age of rugby players, time to surgery, surgical procedure, return to match play and post-operative rehabilitation

Ref.	Mean age of player at surgery Years (range)	Mean time to surgery Months (range)	Type of stabilization	Post-operative treatment	No. of players that returned to competition after surgery	Mean return to competitive match
Neyton et al[23]	23.4 (17-33)	40 (3-163)	Latarjet-Patte procedure (Anterior instability)	Sling for 15 d with passive exercises and no limitation on external rotation. Return to rugby advised at 3 mo	22/34	7 mo (3-24)
Bonnevialle et al[21]	21 (16-34)	4.44 (2-20)	Open Bankart capsular repair	Immobilisation Velpeau bandage for 2-3 wk. No formal physiotherapy	30/31	4.6 mo (2-8)
Larrain et al[26]	22 (16-35)	For acute (all within 3 wk, Recurrent not specified	Arthroscopic acute (39/40)	Not stated	Acute 40/40	Acute: 5.3 mo (4-7)
			Mini open acute (conversion from arthroscopic 1/40)
					Arthroscopic recurrent (121/158)	Recurrent 133/158	Recurrent: 7.5 mo (5.5-9)
			Open recurrent (Latarjet 37/158)
			Goldberg et al[24]	26.5 (23-29)	Not stated: Mean time between presentation and operation 5.9 d (2-15)	2 Stage Open RC suture repair and approximately 9 wk later open capsular repair/osseous bankart repair	After RC repair: sling immobilisation for 6 wk with passive ROM exercise at 3 d. At 6 wk active exercise programe. After Stabilisation: 6 wk immobiisation then passive ROM exercises and light weights after 4 mo	5/6 players (1 player retired because of other injuries)	9 mo
Burkhart et al[25]	Not specified for rugby players	Not specified for rugby players	Arthroscopic capsular ± open capsular shift or Latarjet for when osseous lesion present	3 wk immobilisation in a sling, forward flexion at 3 wk, ER at 6 wk, Strengthening at 8 wk	Not stated	Not stated

ROM: Range of motion.

Table 4 Summary table on patient outcomes, recurrence of instability, complications and study quality

Ref.	Post-operative evaluation tools	Recurrence of instability	Complications	Mean follow up months (range)	Mean Coleman Methodology Score
Neyton et al[23]	Radiographic, Walsh-Duplay score (mean 86), Rowe score (mean 93), VAS score (mean 1.6)	0/37	3/37 (1 glenoid fracture, 1 post op haematoma, 1 pseudoarthrosis of bone block)	144 (68-237)	58
Bonnevialle et al[21]	Mean external rotation decreased 6.2 degrees, Rowe (excellent for 86%), Walsh-Duplay (excellent for 80%), patient satisfaction (88%), Samilson radiographic degeneration in 32%	6/31	None stated	82 (60-120)	48
Larrain et al[26]	Acute: Rowe 33/40 excellent, 4/40 good, 2/40 poor	Arthroscopic acute (2/40)	1/198 (radial paraesthesia)	68.4 (39.6-99.6)	55
	Recurrent: Rowe 105/158 excellent, 6/158 good, 10/158 poor)	Recurrent (10/158)
Goldberg et al[24]	ROM normal except external rotation 70% and internal rotation 60% compared to contra-lateral side	0/6	None	34.3 (12-50)	42.5
Burkhart et al[25]	Not stated	Non osseous lesion (6/87 re-dislocated), osseous (8/9 re-dislocated )	Not specified	Not stated	35

ROM: Range of motion.