Dynamic anterior stabilization for recurrent anterior shoulder instability improves postoperative patient-reported outcomes without restricting shoulder range of motion: a meta-analysis

Dynamic anterior stabilization (DAS) is a novel soft-tissue procedure for treating anterior shoulder instability in selected cases. The purpose of the present meta-analysis is to provide the up-to-date evidence on DAS’s outcomes, safety and characterize study designs to improve future studies and accelerate technical advancements.

A PRISMA guided meta-analysis was performed. Inclusion criteria were human studies, comparative or non-comparative in which DAS was performed as an indication for anterior shoulder instability. Four databases were searched PubMed (via MEDLINE), EMBASE, Web of Science, and Science Direct. ROBINS-I was employed for risk of bias analysis. A random-effects meta-analysis was performed using mean difference (MD) as effect size estimator. Heterogeneity was reported using the I² statistic. Dichotomous variables were counted and reported as % out of total sample size for each study.

Five studies met the inclusion criteria. A total of 137 patients were available for analysis with a mean age of 27.8 ± 9 years and 108 patients were males. Mean follow-up duration was 37 ± 11 months. Postoperative ASES score showed an improvement of MD = -15.09 (95% CI: -22.35 to -7.38), p < 0.01, compared to the preoperative period. The ROWE score showed a similar improvement, MD = -58.38 (95% CI: -69.88 to -46.89), p < 0.01. Postoperative range of motion (ROM) was not significantly influenced. Active anterior elevation had a MD = -6.07° (95% CI: -15.04 to 2.91), p = 0.19, active external rotation had a MD = 3.7° (95% CI: -7.71 to 15.11), p = 0.53, and active internal rotation, MD = 0.16° (95% CI: -1.4 to 1.73), p = 0.84. Return to play ranged from 80 to 100% while return to competitive sports, reported by a single study, was 33%. The overall complication rate was 8.6%. The overall risk of bias was “serious” or “critical” for all included studies.

DAS has been shown to improve postoperative PROMs, does not restrict ROM compared to the preoperative period and has an overall complication rate of 8.6%.