title: Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis.
abstract: BACKGROUND
  Recurrent instability following a first-time anterior traumatic shoulder dislocation may exceed 26%. We systematically reviewed risk factors which predispose this population to events of recurrence.
  
  
  METHODS
  A systematic review of studies published before 1 July 2014. Risk factors which predispose recurrence following a first-time traumatic anterior shoulder dislocation were documented and rates of recurrence were compared. Pooled ORs were analysed using random-effects meta-analysis.
  
  
  RESULTS
  Ten studies comprising 1324 participants met the criteria for inclusion. Recurrent instability following a first-time traumatic anterior shoulder dislocation was 39%. Increased risk of recurrent instability was reported in people aged 40 years and under (OR=13.46), in men (OR=3.18) and in people with hyperlaxity (OR=2.68). Decreased risk of recurrent instability was reported in people with a greater tuberosity fracture (OR=0.13). The rate of recurrent instability decreased as time from the initial dislocation increased. Other factors such as a bony Bankart lesion, nerve palsy and occupation influenced rates of recurrent instability.
  
  
  CONCLUSIONS
  Sex, age at initial dislocation, time from initial dislocation, hyperlaxity and greater tuberosity fractures were key risk factors in at least two good quality cohort studies resulting in strong evidence as concluded in the GRADE criteria. Although bony Bankart lesions, Hill Sachs lesions, occupation, physiotherapy treatment and nerve palsy were risk factors for recurrent instability, the evidence was weak using the GRADE criteria-these findings relied on poorer quality studies or were inconsistent among studies.
authors.affiliation: Auckland University of Technology, Auckland, New Zealand.
authors.forename: M
authors.initials: M
authors.lastname: Olds
authors.affiliation: Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Ellis
authors.affiliation: Auckland University of Technology, Auckland, New Zealand.
authors.forename: K
authors.initials: K
authors.lastname: Donaldson
authors.affiliation: Auckland University of Technology, Auckland, New Zealand.
authors.forename: P
authors.initials: P
authors.lastname: Parmar
authors.affiliation: Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand.
authors.forename: P
authors.initials: P
authors.lastname: Kersten
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D012737:Sex Factors; D012783:Shoulder Dislocation / Q000209:etiology* / Q000473:pathology; D055815:Young Adult
keywords: Epidemiology; Meta-analysis; Recurrent; Risk factor; Shoulder