SHOULDER & ELBOW
Anatomic Bankart repair compared with nonoperative treatment and/or arthroscopic lavage for first-time traumatic shoulder dislocation
Cette étude a été identifiée comme étant potentiellement à fort impact.
L'indicateur High Impact de l'ENP, basé sur l'IA, estime l'influence qu'un article est susceptible d'avoir en intégrant des signaux provenant à la fois de la revue dans laquelle il est publié et du contenu scientifique de l'article lui-même.
Développé à l'aide d'un traitement du langage naturel de pointe, le modèle High Impact de l'ENP prédit avec plus de précision les futures citations d'une étude que le seul facteur d'impact de la revue.
Cela permet d'identifier plus tôt les recherches cliniquement significatives et aide les lecteurs à se concentrer sur les articles les plus susceptibles d'influencer les pratiques futures.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(6):77 Arthroscopy. 2012 Apr;28(4):565-75. doi: 10.1016/j.arthro.2011.11.012. Epub 2012 Feb 144 studies (228 patients) were included in this meta-analysis which compared the outcome of anatomic Bankart repair with both arthroscopic lavage and sling immobilization for the treatment of first time anterior shoulder dislocations at a minimum of 2 years. The results indicated that recurrent instability of the shoulder was significantly reduced through the use of anatomic Bankart repair, and quality of life was improved as measured by the Western Ontario Shoulder Instability questionnaire. Patient satisfaction was similar between treatment methods.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
4/4
Introduction
4/4
Accessing Data
4/4
Analysing Data
4/4
Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
The recurrence rate following primary anterior shoulder dislocation has been reported to be as high as 67 percent when treated with conservative treatments such as sling immobilization. Two surgical interventions, arthroscopic lavage without concomitant capsuloligamentous repair (the gold standard) and anatomic Bankart repair, may reduce this high recurrence rate. However, the ideal management of first-time shoulder dislocation has not been established due to limitations in the analyses of the current literature. The objective of this publication was to perform a systematic review and meta-analysis which compared the efficacy of anatomic Bankart repair with arthroscopic lavage and sling immobilization in treatment of anterior shoulder dislocation.
Quelle était la principale question de recherche ?
Was a lower rate of recurrent instability and improved quality of life achieved in the treatment of anterior shoulder dislocation with the use of anatomic Bankart repair compared to arthroscopic lavage and sling immobilization?
Quels sont les résultats importants ?
- Three different Bankart repair methods were used in the included trials, 1 study used the Caspari technique (transglenoid suture fixation), 1 study used bioabsorbable tacks, and 2 studies used suture anchors.
- Analysis of all 4 trials indicated that recurrent instability was significantly reduced among patients who had received anatomic Bankart repair than those who had received either of the controls (surgical lavage or nonsurgical immobilization). (RR 0.18, 95%CI 0.10-0.33)
- Subgroup analysis indicated that superiority of reduced recurrent instability with anatomic Bankart repair remained when compared separately with arthroscopic lavage (RR 0.14, 95%CI 0.06-0.31) and sling immobilization (RR 0.26, 95%CI 0.10-0.67)
- Quality of life measured in 2 studies with the Western Ontario Shoulder Instability (WOSI) questionnaire significantly favoured treatment with Bankart repair than treatment through lavage and immobilization. (MD -222.02, 95%CI -346.06 to -97.97)
- Analysis of 2 studies which reported patient satisfaction observed no significant difference between anatomic Bankart repair and the control groups. (RR 1.92, 95%CI 0.63-5.87)
- 88.6% of patients identified in the studies were male.
- Complications were not reported.
De quoi dois-je me souvenir en priorité ?
The use of anatomic Bankart repair for the treatment of anterior shoulder dislocation provided improvement in recurrent instability and WOSI-measured quality of life when compared to arthroscopic lavage and sling immobilization. Patient satisfaction was not impacted by type of treatment.
Comment cela affectera-t-il les soins prodigués à mes patients ?
The results of this study suggest that anatomic Bankart repair improved outcomes in patients with first-time shoulder dislocation. However, limitations of the studies included (small sample sizes, nonuniform reporting, short follow-up, unclear methodology and data analysis) require future well-designed studies to effectively determine the efficacy of anatomic Bankart repair compared to other methods of treatment for anterior shoulder dislocation. These studies should use consistent repair methods, uniform outcome measures and should report complication in detail.
AVIS DE NON-RESPONSABILITÉ
Le contenu de cette page est fourni à titre d'information uniquement et n'est pas destiné à remplacer un avis médical, un diagnostic ou un traitement professionnel. Si vous avez besoin d'un traitement médical, demandez toujours l'avis de votre médecin ou rendez-vous au service des urgences le plus proche. Les opinions, croyances et points de vue exprimés par les individus sur le contenu de cette page ne reflètent pas les opinions, croyances et points de vue d'OrthoEvidence.
0 de 4 articles mensuels GRATUITS débloqués
