Evaluation of spin bias in systematic reviews and meta-analyses comparing Bankart repair with remplissage versus the...

Anterior shoulder instability is common in young, active patients and, when managed surgically, is typically treated with either Bankart repair with remplissage or a bony procedure such as Latarjet. Both procedures have demonstrated favorable clinical outcomes, but differences in recurrent instability, complications, functional outcomes, and return-to-sport rates continue to be debated. In the setting of ongoing clinical equipoise and heterogeneous evidence, systematic reviews and meta-analyses may help guide treatment decisions. The aim of this study was to assess the prevalence of spin bias, defined as misrepresentation or overinterpretation of study findings, in the abstracts of systematic reviews comparing these procedures, and its potential influence on clinical decision-making.

A systematic review of systematic reviews and meta-analyses comparing arthroscopic Bankart repair with remplissage to the Latarjet procedure for anterior shoulder instability was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook. MEDLINE and EMBASE were searched from inception to October 29, 2025. Eligible studies were published in English and reported ≥1 clinical outcome. Abstracts were assessed independently in duplicate for 15 domains of spin while the methodological quality of included studies was evaluated using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Descriptive statistics were calculated, and exploratory comparisons were performed for studies with versus without the most common spin types.

Thirteen systematic reviews were included, 7 of which incorporated meta-analyses, with a median of 16 primary studies and 778 shoulders per review. Spin was identified in 12 of 13 abstracts (92.3%), most related to misleading reporting (51.2%) and misleading interpretation (41.5%). Spin Types 5 (claims of benefit despite high risk of bias) and 12 (claims of equivalence despite non-significant results with wide confidence intervals) were most frequent (each 46.2%). No significant associations were identified between the presence of Type 5 or Type 12 spin and study characteristics. AMSTAR-2 assessments revealed 10 systematic reviews with "critically low" and 3 with "low" methodological quality, primarily due to failure to report funding sources, assess the impact of risk of bias, and justify included study designs.

Spin is highly prevalent in abstracts of systematic reviews and meta-analyses comparing Bankart repair with remplissage to the Latarjet procedure. Most included systematic reviews were rated as low or critically low quality by AMSTAR-2, with abstract conclusions frequently overstating benefit or equivalence despite limited evidence. Clinicians should interpret these findings with caution when using systematic reviews to guide management of anterior shoulder instability.