Arthroscopic Bankart Repair Versus Conservative Management for First‐Time Traumatic Anterior Shoulder Instability: A Systematic Review and Meta‐analysis

Purpose To perform a meta‐analysis of the current evidence in the literature comparing arthroscopic Bankart repair versus conservative management for first‐time anterior shoulder dislocation. Methods A literature search of the MEDLINE, Embase, and Cochrane Library databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐analyses) guidelines. Prospective studies comparing arthroscopic Bankart repair versus conservative management as treatment for first‐time anterior shoulder dislocation were included. Recurrence, further treatment, and return to play were compared, with all statistical analysis performed using Review Manager, version 5.3. P < .05 was considered statistically significant. Results Ten prospective studies with 569 patients were included. Arthroscopic Bankart repair resulted in a lower rate of total recurrent instability (9.7% vs 67.4, I 2 = 0, P < .0001) and further surgical treatment for anterior shoulder instability (5.9% vs 46.7%, I 2 = 0, P < .0001). Additionally, arthroscopic Bankart repair resulted in a higher rate of return to play (92.8% vs 80.8%, I 2 = 0, P = .002). Conclusions Arthroscopic Bankart repair resulted in a 7‐fold lower recurrence rate and a higher rate of return to play than conservative management. Thus, arthroscopic Bankart repair may be advisable to perform routinely in patients with first‐time dislocation who participate in sports. Level of Evidence Level II, systematic review of Level I and II studies.