Surgical Versus Nonoperative Treatment in Patients Up to 18 Years Old With Traumatic Shoulder Instability: A Systematic Review and Quantitative Synthesis of the Literature

PURPOSE: To compare the outcome of surgical and nonoperative treatment in patients aged 18 years or younger with traumatic shoulder instability. METHODS: A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A complete search of PubMed, Medline, Cochrane, CINAHL, Embase, and Google Scholar databases was performed using various combinations of the keywords "shoulder," "instability," "glenohumeral instability," "pediatric," "adolescent," "skeletally immature," "young," "open physis," "children," "management," "treatment," "surgical," "stabilization," and "recurrence." There was no time restriction. RESULTS: Fifteen articles met our inclusion criteria, including a total of 693 patients with 705 shoulders aged 18 years or younger. Of 411 shoulders, 293 (71.3%) treated with a nonoperative approach experienced a redislocation compared with 55 of 314 shoulders (17.5%) that received surgical treatment. The results of the quantitative synthesis showed that the recurrence rate was significantly lower in the surgical group compared with the nonoperative group. CONCLUSIONS: The recurrence rate is lower in patients undergoing surgical treatment. Further studies are necessary to clarify several points in the treatment of skeletally immature patients with traumatic shoulder instability. LEVEL OF EVIDENCE: Level III, systematic review of Level II and III studies and 1 case series.