title: Effects of surgical management on multidirectional instability of the shoulder: a meta-analysis.
abstract: OBJECTIVE
  The purpose of this study was to assess the effectiveness of arthroscopic and open surgical techniques on the treatment of shoulder multidirectional instability.
  
  
  METHODS
  Literature searches were conducted using the databases MEDLINE, Embase, ClinicalTrials.gov, the Cochrane Library, and the Cochrane Central Register of Controlled Trials. Original articles on the surgical management of multidirectional instability were retrieved against selection criteria. Data were extracted and divided into three groups by surgical technique. Proportion and mean meta-analyses were performed for comparison.
  
  
  RESULTS
  The available evidence was from 35 level IV and 1 level II studies. The recurrent instability rate was 9.9 % (95 % CI 7.3-12.9 %) in open capsular shift (OCS) group and 6.0 % (95 % CI 3.7-8.9 %) in arthroscopic capsular plication (ACP) group, between which no difference was observed. However, thermal capsular shrinkage (TCS) group resulted in a recurrent instability rate of 23.9 % (95 % CI 16.6-32.2 %), significantly higher than the above two groups. OCS and ACP groups revealed low reoperation rates of approximately 5.2 % (95 % CI 2.7-8.5 %) and 4.8 % (95 % CI 2.3-8.0 %), respectively, which are lower than that in TCS group of 16.9 % (95 % CI 12.4-21.8 %). OCS caused more loss of external rotation than ACP, losing 7.0 (95 % CI 3.3-10.6) degrees versus 2 (95 % CI 0.9-2.4) degrees, respectively.
  
  
  CONCLUSIONS
  ACP and OCS techniques have similar primary outcomes, but the former causes less post-operative stiffness. It is suggestible to avoid TCS in the treatment of MDI.
  
  
  METHODS
  Level IV.
authors.affiliation: Orthopaedic Department, Goulburn Valley Health, The University of Melbourne, Shepparton, VIC, 3630, Australia. dongchen.cd@gmail.com.
authors.forename: Dong
authors.initials: D
authors.lastname: Chen
authors.affiliation: Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Jerome
authors.initials: J
authors.lastname: Goldberg
authors.affiliation: Orthopaedic Department, Bankstown Hospital, University of Western Sydney, Sydney, NSW, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Herald
authors.affiliation: Orthopaedic Department, Goulburn Valley Health, The University of Melbourne, Shepparton, VIC, 3630, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Critchley
authors.affiliation: Orthopaedic Department, Goulburn Valley Health, The University of Melbourne, Shepparton, VIC, 3630, Australia.
authors.forename: Arshad
authors.initials: A
authors.lastname: Barmare
mesh_terms: D001182:Arthroscopy; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D012782:Shoulder / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery*
keywords: Arthroscopic capsular plication; Electrothermal arthroscopic capsulorrhaphy; Multidirectional instability; Open inferior capsular shift; Recurrent instability; Shoulder