Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis.

Autor:	Kavaja L; Medical Faculty, University of Helsinki, Helsinki, Finland.; Department of Surgery, South Carelia Central Hospital, Lappeenranta, Finland., Lähdeoja T; Medical Faculty, University of Helsinki, Helsinki, Finland.; Finnish Center of Evidence-based Orthopaedics (FICEBO), University of Helsinki, Helsinki, Finland.; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Töölö Hospital, Helsinki, Finland., Malmivaara A; Centre for Health and Social Economics, Institute of Health and Welfare, Helsinki, Finland.; Orton Orthopaedic Hospital and Orton Research Institute, Orton Foundation, Helsinki, Finland., Paavola M; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Töölö Hospital, Helsinki, Finland.
Jazyk:	angličtina
Zdroj:	British journal of sports medicine [Br J Sports Med] 2018 Dec; Vol. 52 (23), pp. 1498-1506. Date of Electronic Publication: 2018 Jun 23.
DOI:	10.1136/bjsports-2017-098539
Abstrakt:	Objective: To review and compare treatments (1) after primary traumatic shoulder dislocation aimed at minimising the risk of chronic shoulder instability and (2) for chronic post-traumatic shoulder instability. Design: Intervention systematic review with random effects network meta-analysis and direct comparison meta-analyses. Data Sources: Electronic databases (Ovid MEDLINE, Cochrane Clinical Trials Register, Cochrane Database of Systematic Reviews, Embase, Scopus, CINAHL, Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, DARE, HTA, NHSEED, Web of Science) and reference lists were searched from inception to 15 January 2018. Eligibility Criteria for Selecting Studies: Randomised trials comparing any interventions either after a first-time, traumatic shoulder dislocation or chronic post-traumatic shoulder instability, with a shoulder instability, function or quality of life outcome. Results: Twenty-two randomised controlled trials were included. There was moderate quality evidence suggesting that labrum repair reduced the risk of future shoulder dislocation (relative risk 0.15; 95% CI 0.03 to 0.8, p=0.026), and that with non-surgical management 47% of patients did not experience shoulder redislocation. Very low to low-quality evidence suggested no benefit of immobilisation in external rotation versus internal rotation. There was low-quality evidence that an open procedure was superior to arthroscopic surgery for preventing shoulder redislocations. Conclusions: There was moderate-quality evidence that half of the patients managed with physiotherapy after a first-time traumatic shoulder dislocation did not experience recurrent shoulder dislocations. If chronic instability develops, surgery could be considered. There was no evidence regarding the effectiveness of surgical management for post-traumatic chronic shoulder instability. Competing Interests: Competing interests: None declared. (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
Databáze:	MEDLINE
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