title: Evidence in managing traumatic anterior shoulder instability: a scoping review.
abstract: BACKGROUND
  Traumatic anterior shoulder instability (TASI) accounts for 95% of glenohumeral dislocations and is associated with soft tissue and bony pathoanatomies. Non-operative treatments include slings, bracing and physiotherapy. Operative treatment is common, including bony and soft-tissue reconstructions performed through open or arthroscopic approaches. There is management variation in patient pathways for TASI including when to refer and when to operate.
  
  
  METHODS
  A scoping review of systematic reviews, randomised controlled trials, comparing operative with non-operative treatments and different operative treatments were the methods followed. Search was conducted for online bibliographic databases and reference lists of relevant articles from 2002 to 2012. Systematic reviews were appraised using AMSTAR (assessment of multiple systematic reviews) criteria. Controlled trials were appraised using the CONSORT (consolidation of standards of reporting trials) tool.
  
  
  RESULTS
  Analysis of the reviews did not offer strong evidence for a best treatment option for TASI. No studies directly compare open, arthroscopic and structured rehabilitation programmes. Evaluation of arthroscopic studies and comparison to open procedures was difficult, as many of the arthroscopic techniques included are no longer used. Recurrence rate was generally considered the best measure of operative success, but was poorly documented throughout all studies. There was conflicting evidence on the optimal timing of intervention and no consensus on any scoring system or outcome measure.
  
  
  CONCLUSIONS
  There is no agreement about which validated outcome tool should be used for assessing shoulder instability in patients. There is limited evidence regarding the comparative effectiveness of surgical and non-surgical treatment of TASI, including a lack of evidence regarding the optimal timing of such treatments. There is a need for a well-structured randomised control trial to assess the efficacy of surgical and non-surgical interventions for this common type of shoulder instability.
authors: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK.
authors: A Paul
authors: AP
authors: Monk
authors: Nuffield Orthopaedic Centre, Oxford, UK.
authors: Patrick
authors: P
authors: Garfjeld Roberts
authors: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK.
authors: Kartik
authors: K
authors: Logishetty
authors: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK.
authors: Andrew J
authors: AJ
authors: Price
authors: Department of Orthopaedics, Royal Gwent Hospital, Newport, UK.
authors: Rohit
authors: R
authors: Kulkarni
authors: School of Medicine & Health, Durham University, Stockton-on-Tees, UK.
authors: Amar
authors: A
authors: Rangan
authors: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK.
authors: Jonathan L
authors: JL
authors: Rees
mesh_terms: D001182:Arthroscopy / Q000379:methods / Q000534:rehabilitation; D006801:Humans; D007593:Joint Instability / Q000628:therapy*; D015588:Observer Variation; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012086:Reoperation; D012783:Shoulder Dislocation / Q000534:rehabilitation / Q000628:therapy*; D000070599:Shoulder Injuries; D013536:Suture Techniques; D061665:Time-to-Treatment
keywords: Evidence based reviews; Orthopaedics; Physiotherapy; Shoulder injuries; Trauma surgery