title: Anatomic Bankart repair compared with nonoperative treatment and/or arthroscopic lavage for first-time traumatic shoulder dislocation.
abstract: OBJECTIVE
  The objective of this systematic review was to determine the efficacy of anatomic Bankart repair in patients with a first-time shoulder dislocation compared with either arthroscopic lavage or traditional sling immobilization.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, Web of Science, LILACS, and a clinical trials registry for ongoing and completed randomized or quasi-randomized controlled trials comparing anatomic Bankart repair with either rehabilitation or arthroscopic lavage. Two reviewers selected studies for inclusion, assessed methodologic quality, and extracted data. Pooled analyses were performed by use of a random-effects model, and risk ratio (RR) and 95% confidence intervals (CIs) were computed.
  
  
  RESULTS
  We included 3 randomized trials and 1 quasi-randomized trial comprising 228 patients. Of the included trials, 2 compared anatomic Bankart repair with sling immobilization whereas 2 compared Bankart repair with arthroscopic lavage. A meta-analysis of all 4 trials showed that the rate of recurrent instability was significantly lower among participants undergoing anatomic Bankart repair compared with those undergoing either immobilization or arthroscopic lavage (RR, 0.18; 95% CI, 0.10 to 0.33). Subgroup analysis showed that this effect persisted when Bankart repair was compared with arthroscopic lavage alone (2 studies) (RR, 0.14; 95% CI, 0.06 to 0.31) or sling immobilization alone (2 studies) (RR, 0.26; 95% CI, 0.10 to 0.67). Western Ontario Shoulder Instability scores were better with anatomic Bankart repair compared with either arthroscopic lavage or immobilization (2 studies) (mean difference, -232; 95% CI, -317 to -146).
  
  
  CONCLUSIONS
  There is evidence to suggest treatment of young patients with a first-time shoulder dislocation with anatomic Bankart repair with the goal of lowering the rate of recurrent instability over the long-term and improving short-term quality of life.
  
  
  METHODS
  Level II, systematic review of Level I and II studies.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. jaschahal@hotmail.com
authors.forename: Jaskarndip
authors.initials: J
authors.lastname: Chahal
authors.forename: Paul H
authors.initials: PH
authors.lastname: Marks
authors.forename: Peter B
authors.initials: PB
authors.lastname: Macdonald
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
authors.forename: John
authors.initials: J
authors.lastname: Theodoropoulos
authors.forename: Bheeshma
authors.initials: B
authors.lastname: Ravi
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Whelan
mesh_terms: D001182:Arthroscopy; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000628:therapy; D011788:Quality of Life; D012008:Recurrence; D012149:Restraint, Physical; D012783:Shoulder Dislocation / Q000209:etiology / Q000628:therapy*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome