SHOULDER & ELBOW
Anatomic Bankart repair compared with nonoperative treatment and/or arthroscopic lavage for first-time traumatic shoulder dislocation
Este estudo foi identificado como tendo um impacto potencialmente elevado.
A métrica de Alto Impacto da OE, baseada em IA, estima a influência que um artigo poderá ter, integrando sinais da revista em que foi publicado e do conteúdo científico do próprio artigo.
Desenvolvido com recurso ao mais avançado processamento de linguagem natural, o modelo High Impact da OE prevê com maior precisão o desempenho futuro de um estudo em termos de citações do que o fator de impacto da revista por si só.
Isto permite o reconhecimento precoce de investigação clinicamente significativa e ajuda os leitores a concentrarem-se nos artigos com maior probabilidade de moldar a prática futura.
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?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
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
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
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?
Quais foram os resultados importantes?
- 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 que é que me devo lembrar mais?
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.
Como é que isto afectará o tratamento dos meus doentes?
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.
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