OJOOpen Journal of Orthopedics2164-3008Scientific Research Publishing10.4236/ojo.2017.79026OJO-78886ReviewMedicine&Healthcare Complications of Surgical Treatment of Anterior Shoulder Dislocation: A Systematic Review WalterHugo Brandão Nascimento1LailsonOliveira de Castro2*Liwerbethdos Anjos Pereira2JoãoPaulo Pimentel de Sousa2PauloRenan Matos Sucupira Cunha1RodrigoMartins Silva Caetano3Preceptor of the Medical Residency in Orthopedics and Traumatology, University Hospital of the Universidade Federal do Maranhão, São Luís, BrazilResident Physician in Orthopedics and Traumatology, University Hospital of the Universidade Federal do Maranhão, São Luís, BrazilScholarship Holder, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), São Luís, Brazil* E-mail:lailson.oliveira@outlook.com(LODC);010920170709241253June 22, 2017Accepted: September 1, September 4, 2017© Copyright 2014 by authors and Scientific Research Publishing Inc. 2014This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

Introduction: shoulder joint has the greatest range of motion in the human body. The shoulder anatomy promotes high mobility and favors relative sacrifice of articular stability, making it susceptible and more prone to events of instability and dislocation. This review aimed at identifying main complications of surgical treatment of anterior shoulder dislocation. Methodology: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Studies which were eligible for this systematic review included: English or Spanish language, studies published from 2000, which mentioned surgical complications of anterior shoulder dislocation in their results, both in open and arthroscopic surgery. Included studies which were required to have at least 1 complication following surgical repair. Only studies from original data were included. Results: We found 228 potentially eligible studies for the survey. Through the inclusion and exclusion criteria and after consensus among reviewers, we chose 9 studies to compose the systematic review. Conclusion: Important information emerges: recurring instability, recurring dislocation, external rotation limitation and arthritis are main surgical complications of anterior shoulder dislocation.

Surgical Complications Anterior Shoulder Dislocation and Recurrences1. Introduction

The shoulder joint has the greatest range of motion in the human body. Its anatomy promotes high mobility [1] and favors relative sacrifice of articular stability, making it susceptible and more prone to events of instability and dislocation [2] [3] . The mechanism of injury often occurs due to a trauma that combines abduction, hyperextension and external rotation of the shoulder. This mechanism conditions the anterior glenohumeral dislocation or subluxation causing ruptures of the joint capsule and pulling of glenoid labrum in its anteroinferior portion, i.e. the Bankart lesion. The glenoid defect may be due to a primary fracture or due to a bone lesion caused by episodes of repeated subluxations or dislocations, and it is commonly observed in patients with anterior shoulder dislocation [4] [5] . The glenoid bone defect proved to alter normal shoulder kinematics, resulting in shoulder anterior instability and additional redislocation [5] [6] .

The paradigm of these lesions is anterior dislocations and anterior instability. Thus, it is estimated that the shoulder dislocation has incidence of 23.9/100,000, and 98% correspond to previous dislocations. With a peak of bimodal incidence, the 15 - 29 age group shows 46.8% of shoulder dislocations, with another peak of incidence in the group of 61 - 80 age related to low-energy trauma [7] [8] . A review of the National Collegiate Athletic Association (NCAA) analyzed an injury surveillance system during the years 1989 to 2004 reporting 2080 glenohumeral instabilities in various sports and equating the rate of injuries in 0.12/1000 exposed athletes, most in sports such as football, wrestling and hockey [9] [10] .

Articular shoulder lesions and the number of recurrences (dislocations or subluxations) associated with anterior shoulder instability are determinant in their therapeutic approach [11] . The best knowledge of contributing factors of complications in each treatment increases the high importance of preventing adverse effects resulting from therapeutic management.

In addition to the general complications of surgery and recurrent shoulder instability, other problems were described after surgical stabilization. The most commonly encountered complications are pain, loss of motion, infection, implant release, neurovascular injury, and late articular degeneration. After arthroscopic stabilization, neurovascular lesions, adhesive capsulitis and synovial fistula are found. Other complications are specific to the surgical technique used for Bankart lesion and include laxity, fractures and interlocking after using clamps, suprascapular nerve lesions and pain after transglenoid repair [12] [13] .

Complications related to the surgical treatment of anterior shoulder dislocation in the orthopedic and traumatology services are common worldwide. The analysis of the current literature shows lack of consensus regarding the complications of surgical treatment of instability and anterior shoulder dislocation, and which therapeutic approach guarantees the best results, especially in relapsing situations. In this sense, this review identified main complications of surgical treatment of anterior shoulder dislocation.

2. Methods2.1. Literature Search Strategy

This systematic review was conducted according to the International Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. We performed searches on the PubMed and LILACS electronic databases in July 2017. To achieve the maximum sensitivity in the search strategy, we used the descriptor “anterior shoulder dislocation” according to the Medical Subject Headings (MeSH).

2.2. Eligibility Criteria

Studies eligible for this systematic review included: English or Spanish language, studies published from 2000, which mentioned surgical complications of anterior shoulder dislocation in their results, both in open and arthroscopic surgery. Included studies were required to have at least 1 complication following surgical repair. Only studies from original data were included. Abstracts, case report, qualitative study, conference presentation, editorial, review, cross-sectional study, biomechanical study, pilot study, cohort, studies addressing cancer patients, pediatric-patient studies and expert opinions were excluded.

2.3. Qualitative Evaluation

Two independent reviewers (L.O.C and J.P.P.S) evaluated each article and found agreement on any disagreement about including or excluding studies due to controversy in their selection. The International Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) checklist were used to evaluate the quality of studies. Two orthopedic surgeons (W.H.B.N and P.R.M.S.S) were consulted on the included references.

2.4. Extracted Data

Data were extracted from texts, tables and figures of all articles included in the study.

2.5. Selection Steps

Procedures were organized following the International Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines: at first, we conducted a survey of studies on the databases using the proposed descriptors; secondly, we have removed studies in duplicate; and subsequently we selected studies from the title, abstract and formation of a systematized database. In the eligibility stage, selected studies were read in full and stored in a new database. In the inclusion stage, we discussed studies according to the pertinent literature to establish consensus and divergent points in the literature and produce a critical summary summarizing the information provided by the included articles.

3. Results

We found 228 potentially eligible studies for review and 4 duplicate studies were removed. Initially, reviewers L.O.C and J.P.P.S evaluated titles and abstracts of these publications, and 192 references were excluded. After selection through the abstracts, we selected 32 studies that were read in full by the two independent reviewers. The complete reading of studies resulted in the exclusion of 7 articles in the German language [14] - [20] , 2 studies that did not involve surgical procedures [21] [22] , 9 studies without surgical complications [23] - [31] , 3 studies comparing the types of sutures [32] [33] [34] , 1 study published before 2000 [35] and 1 study with impossibility of access [36] . Through the inclusion and exclusion criteria and after consensus among reviewers, 9 studies were selected to compose the systematic review [37] - [45] (Figure 1).

A total of 1016 patients were investigated in the 9 studies included in this systematic review. Open surgery was used in 175 of these patients, while arthroscopic surgery occurred in 216 patients. Forty-two patients underwent capsular arthroscopic lavage, 31 were submitted to T-plasty procedure and Bankart repair. The coracoid process transfer occurred in 219 patients and 217 were submitted to open soft tissue reconstruction. Thirty-one patients underwent modified and anatomically oriented anteroinferior capsule change and Bankart repair, and 25 patients underwent surgery using theBoytchev technique. The average follow-up was five years and eight months; minimum follow-up of one year and eight months and maximum follow-up of 13 years and four months. Papers selected for this Systematic Review are summarized in Table 1.

In this systematic review, we identified 227 surgical complications of anterior shoulder dislocation. Complications included: 22 returns of instability, 40 returns of dislocation, 1 infection, 104 osteoarthritis, 11 external rotation limitations, 2 erythema, 3 adhesive capsulitis, 8 recurrent subluxations, 5 laxity with

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