Eoghan T. Hurley, Bogdan A. Matache, IvanWong, Eiji Itoi, Eric J. Strauss, Ruth A. Delaney, Lionel Neyton, George S. Athwal, LeoPauzenberger, HannanMullett, Laith M.Jazrawi, The Anterior Shoulder Instability International Consensus Group
The purpose of this study was to establish consensus statements via a modified Delphi process on the diagnosis, non-operative management, and Bankart repair for anterior shoulder instability.
A consensus process on the treatment utilizing a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability.
The independent factors identified in the 2 statements that reached unanimous agreement in diagnosis and non-operative management were: age, gender, mechanism of injury, number of instability events, whether reduction was required, occupation, sport/position/level played, collision sport, glenoid or humeral bone-loss, and hyperlaxity. Of the 3 total statements reaching unanimous agreement in Bankart repair, additional factors included overhead sport participation, prior shoulder surgery, patient expectations, and ability to comply with post-operative rehabilitation. Additionally, there was unanimous agreement that complications are rare following Bankart repair, and that recurrence rates can be diminished by a well-defined rehabilitation protocol, inferior anchor placement (5-8mm apart), multiple small-anchor fixation points, treatment of concomitant pathologies, careful capsulolabral debridement/reattachment, and appropriate indications/assessment of risk factors.
Overall, 84% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were the aspects of patient history that should be evaluated in those with acute instability, the prognostic factors for non-operative management and Bankart repair. Furthermore, there was unanimous consensus on the steps to minimize complications for Bankart repair, and the placement of anchors 5-8mm apart. Finally, there was no consensus on the optimal position for shoulder immobilization.
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