Arthroscopic vs open surgery for shoulder dislocation and instability: A network meta-analysis of treatment outcomes

BACKGROUND: No comprehensive comparative research has been conducted to evaluate open Bankart (OB), arthroscopic Bankart (AB), open Latarjet (OL), and arthroscopic Latarjet (AL) simultaneously across all relevant clinical outcomes and parameters. OBJECTIVES: To compare the efficacy of OB, AB, OL, and AL procedures in the treatment of shoulder dislocation. MATERIAL AND METHODS: The databases PubMed, Embase, the Cochrane Library, and Web of Science were utilized for the literature search. The study evaluated recurrent instability, re-dislocation, apprehension, functional outcomes, and postoperative pain. The results were visually represented through network diagrams, forest plots, league tables, and rank probability plots to provide a comprehensive understanding of each outcome. RESULTS: Overall, 37 studies were included in the analysis. Individuals who underwent OL experienced a notably reduced risk of recurrent instability compared with those who underwent AB (random-effects model pooled relative risk (RR) = 0.34, 95% credible interval (95% CrI): 0.24-0.48) and OB (random-effects model pooled RR = 0.51, 95% CrI: 0.31-0.85). The risk of re-dislocation was also significantly lower for patients treated with OL compared with AB (pooled RR = 0.15, 95% CrI: 0.04-0.45). While not statistically significant, the OL procedure tended to have the lowest risk of apprehension and the highest Subjective Shoulder Value (SSV) score. Regarding postoperative pain, patients who underwent OB had the highest likelihood of attaining the lowest scores on the visual analogue scale (VAS). In addition, OL was associated with the highest probability of complications. CONCLUSION: The open Latarjet procedure appears to offer superior shoulder stability; however, while functional outcomes for patients undergoing OL are likely to be non-inferior, the procedure is not significantly associated with reduced postoperative pain as measured with the VAS score. Additionally, the OL procedure is associated with an increased likelihood of complications. Consequently, it is essential to implement preventive measures to manage postoperative pain and address potential complications following OL procedure.