title: The Influence of Evidence-Based Surgical Indications and Techniques on Failure Rates After Arthroscopic Shoulder Stabilization in the Contact or Collision Athlete With Anterior Shoulder Instability.
abstract: BACKGROUND
  It has been reported that arthroscopic shoulder stabilization yields higher rates of failure in contact or collision athletes as compared with open shoulder stabilization; however, this is largely based upon studies that do not employ modern, evidence-based surgical indications and techniques for arthroscopic shoulder stabilization.
  
  
  OBJECTIVE
  To (1) determine the pooled failure rate across all studies reporting failure after primary arthroscopic shoulder stabilization for anterior shoulder instability in contact or collision athletes and (2) stratify failure rates according to studies that use evidence-based surgical indications and techniques.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  A review of PubMed, Medline, and Embase was performed to identify all clinical studies with a minimum of 1-year follow-up that reported failure rates after arthroscopic shoulder stabilization for anterior shoulder instability in contact or collision athletes. Data pertaining to patient demographics, clinical and radiographic preoperative assessment, surgical indications, surgical technique, rehabilitation, and outcome were collected from each included study. An overall failure rate was determined across all included studies. After this, a secondary literature review was performed to identify factors related to patient selection and surgical technique that significantly influence failure after primary arthroscopic shoulder stabilization. Failure rates were then determined among included studies that used these evidence-based indications and techniques.
  
  
  RESULTS
  Overall, 26 studies reporting on 779 contact or collision athletes met the inclusion criteria. The mean patient age was 19.9 years, 90.3% were male, and the most common sport was rugby. There was considerable variability in the reporting of patient demographics, preoperative assessment, surgical indications, surgical technique, and patient outcomes. Across all included studies, the pooled failure rate after arthroscopic shoulder stabilization in the contact or collision athlete was 17.8%; however, among studies that excluded patients with significant bone loss, used a minimum of 3 suture anchors, and performed the stabilization in the lateral decubitus position, the failure rate was 7.9%.
  
  
  CONCLUSIONS
  The rate of failure after arthroscopic shoulder stabilization in contact or collision athletes decreases from 17.8% to 7.9% after the use of evidence-based surgical indications and techniques.
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.|Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors: Timothy S
authors: TS
authors: Leroux
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors: Bryan M
authors: BM
authors: Saltzman
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors: Maximilian
authors: M
authors: Meyer
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors: Rachel M
authors: RM
authors: Frank
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors: Bernard R
authors: BR
authors: Bach
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors: Brian J
authors: BJ
authors: Cole
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors: Anthony A
authors: AA
authors: Romeo
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors: Nikhil N
authors: NN
authors: Verma
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes; D001265:Athletic Injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D012785:Shoulder Joint / Q000601:surgery*; D055815:Young Adult
keywords: arthroscopic shoulder stabilization; contact athletes; failure