Recurrence, Return to Sport, and Reoperation Rates Appear Similar Between Males And Females After Surgery for Anterior Shoulder Instability: Future Research Requires Disaggregation by Sex

Kenneth T Nguyen; Patrick C Ryan; Erin L Brown; Shreya M Saraf; Mia V Rumps; Mary K Mulcahey

doi:10.1016/j.arthro.2024.11.091

Recurrence, Return to Sport, and Reoperation Rates Appear Similar Between Males And Females After Surgery for Anterior Shoulder Instability: Future Research Requires Disaggregation by Sex

Arthroscopy. 2025 Jan 16:S0749-8063(24)01023-5. doi: 10.1016/j.arthro.2024.11.091. Online ahead of print.

Authors

Kenneth T Nguyen¹, Patrick C Ryan², Erin L Brown¹, Shreya M Saraf³, Mia V Rumps³, Mary K Mulcahey⁴

Affiliations

¹ Tulane University School of Medicine, New Orleans, LA.
² Department of Orthopaedics, Stony Brook Medicine.
³ Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center.
⁴ Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center. Electronic address: [email protected].

PMID: 39826663
DOI: 10.1016/j.arthro.2024.11.091

Abstract

Purpose: The purpose of this study was to evaluate sex-based disparities in outcomes following surgery for anterior shoulder instability and to assess the quality of the current literature on this topic.

Methods: Following PRISMA guidelines, a June 2023 database search (PubMed, Web of Science, Embase, Cinahl) identified level I-III clinical studies on anterior shoulder instability (Jan 2003-May 2023). Eligible studies included male and female outcomes after anterior shoulder stabilization. Systematic reviews, case reports, and case series were excluded. A meta-analysis examined sex-specific results: recurrence, reoperation, return to sport, ASES score, and WOSI index.

Results: The initial search identified 7,028 studies, with 14 meeting inclusion criteria, totaling 1,262 patients (73.9% male, 26.1% female). 53% of studies were excluded due to failure to disaggregate by sex. The meta-analysis found comparable outcomes by sex for recurrence (OR = 1.05; 95% CI = 0.74-1.50; P = .77), reoperation rate (OR = 0.84; 95% CI = 0.69-1.02; P = .08), or RTS (OR = 1.09; 95% CI = 0.54-2.22; P = .81) after arthroscopic Bankart, open Bankart, and open Latarjet procedures. Mean ASES scores were 91.08 ± 13.59 SEM for males and 89.85 ± 16.73 SEM for females, while WOSI scores were 81.32 ± 19.23 SEM and 87.26 ± 14.09 SEM, respectively. Comparable outcomes were found in ASES (MD = -1.20; 95% CI = -4.28-1.88; P = .45) or WOSI scores (MD = 4.94; 95% CI = -0.31-10.00; P = .06).

Conclusion: Recurrence, return to sport, and reoperation rates were similar between males and females after arthroscopic Bankart, open Bankart, and open Latarjet procedures. Comparable outcomes were found in postoperative ASES and WOSI scores between sexes. A majority of relevant studies were excluded due to lack of disaggregation by sex, limiting the certainty of the conclusion and suggesting an opportunity to improve future research.

Level of evidence: Level III, systematic review of Levels I and III studies.

Publication types

Review