Table 2 Summary of the included papers

Hovelius et al. [10]

255 patients

Prognostic level 1 prospective >80 % follow-up

The effectiveness of non-operative treatment (immobilisation) of primary anterior shoulder dislocation in patients up to the age of 40

Half of the primary anterior shoulder dislocations that had been treated non-operatively in patients aged between 12 and 25 years had not recurred and had become stable over time

Maquieira et al. [7]

14 patients

Therapeutic level 4 case series

To observe patients with large (>5 mm), displaced (>2 mm) non-operatively treated anterior glenoid rim fractures

Traumatic anterior shoulder dislocation with a large, displaced rim fracture can be treated successfully without surgery, provided the glenohumeral joint is concentrically reduced

Buss et al. [12]

30 patients

Therapeutic level 4 case series

To determine if in-season athletes can be returned to their sports quickly and effectively after non-operative treatment of an anterior instability episode

Most young athletes were able to return to their sport and complete their seasons after an episode of anterior shoulder instability, although 37 % experienced at least one additional episode of instability during the season. However, the long-term effect of conservative treatment was not determined in this study

Bottoni et al. [13]

24 patients

Therapeutic level 1 prospective randomized clinical trial

To determine whether early arthroscopic treatment for shoulder dislocation can result in a lower recurrence rate than non-operative treatment

Arthroscopic stabilisation (Bankart repair) of traumatic, first-time anterior shoulder dislocations is effective and significantly reduces the recurrence rate when compared with conventional non-operative therapy

Kiss et al. [11]

59 patients

Therapeutic level 3 retrospective comparative

To assess the results of the non-operative treatment of patients who were referred to a tertiary unit with a diagnosis of multidirectional instability and were treated with a rehabilitation programme with no planned surgical intervention

Conservatively treated patients with multidirectional shoulder instability developed more confidence in everyday activities and had a better understanding of their shoulder condition despite persisting clinical signs of laxity and instability. Patients who had undergone previous shoulder surgery, sustained a work-related injury or had psychological problems were unlikely to benefit from the rehabilitation programme

Kuroda et al. [8]

341 patients

Prognostic level 4 case series

To follow the natural course of atraumatic shoulder instability

Spontaneous recovery occurred in 50 cases. The incidence of spontaneous recovery in the group that discontinued overhead sports was 8.7 times greater than in the group that continued to play overhead sports

Wintzell et al. [15]

30 patients

Therapeutic level 1 prospective randomized

The clinical value and the treatment results of arthroscopic lavage on patients with traumatic primary anterior shoulder dislocation

Arthroscopic lavage significantly reduced the risk of recurrent anterior shoulder dislocation in young patients when compared with non-operative treatment

Arciero et al. [14]

36 patients

Therapeutic level 2 prospective comparative

To study arthroscopic Bankart repair versus non-operative treatment for acute, initial anterior shoulder dislocation

Arthroscopic Bankart repair significantly reduced the rate of recurrence in young athletes compared to non-operative measures