Conservative Versus Operative Management of Pediatric Isolated Anterior Shoulder Instability: A Systematic Review and...

Area of Science:

• Orthopedic Surgery
• Pediatric Sports Medicine
• Traumatology

Background:

• Anterior shoulder instability (dislocations/subluxations) is common in pediatric patients (≤19 years).
• Recurrent instability can lead to long-term functional deficits.
• Optimal management strategies for pediatric shoulder instability lack consensus.

Purpose of the Study:

• To compare the efficacy of conservative versus operative treatments for traumatic, isolated anterior shoulder instability in pediatric populations.
• To evaluate recurrence rates and return to play (RTP) at pre-injury levels as primary outcome measures.
• To provide a contemporary analysis of evolving treatment strategies.

Main Methods:

• Systematic review of studies published between 2013-2023 involving pediatric patients (≤19 years) with anterior shoulder instability.
• Comparison of recurrence rates and RTP between conservative and operative treatment groups.
• Meta-analysis using fixed-effects or random-effects models to estimate pooled odds ratios.

Main Results:

• Higher recurrence rates were observed in the conservative group (43.5%) compared to primary operative (20.8%) and secondary operative (7.7%) groups.
• Meta-analysis showed a significantly higher likelihood of recurrent instability with conservative management (OR = 9.55; p < 0.001).
• Return to play rates were not significantly different between conservative and operative groups (OR = 3.11; p = 0.33).

Conclusions:

• Early surgical intervention is recommended for pediatric patients to minimize recurrence and enhance functional outcomes.
• Conservative management may be suitable for less severe injuries (subluxations) but generally has higher recurrence rates.
• Further research is needed to differentiate optimal strategies for subluxations versus dislocations and consider patient-specific factors.