{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:40:27Z","timestamp":1790775627689,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2016,7,31]],"date-time":"2016-07-31T00:00:00Z","timestamp":1469923200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2016,7,31]],"date-time":"2016-07-31T00:00:00Z","timestamp":1469923200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2016,7,31]],"date-time":"2016-07-31T00:00:00Z","timestamp":1469923200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.jp","clinicalkey.com","clinicalkey.es","arthroscopyjournal.org","clinicalkey.com.au","clinicalkey.fr","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To (1) define the cumulative recurrence rate after primary anterior shoulder dislocation in Level I and II comparative studies and (2) to pool risk ratios for common risk factors to provide a clinically practical hierarchy of modifiable and nonmodifiable risk factors for recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Level I and II prognostic studies were identified using the electronic databases CINAHL, Embase, and MEDLINE from inception to December 2014. Included studies (n\u00a0= 15) had recurrent dislocation as the main outcome, and a minimum 2\u2010year follow\u2010up. The cumulative odds ratio of prognostic factors was calculated where appropriate. Bias was assessed in each study using the Quality in Prognosis Studies (QUIPS) tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The reported rate of recurrence ranged from 19% to 88% (pooled overall\u00a0= 21%; pooled Level I only\u00a0= 47%). The pooled time to recurrence was 10.8\u00a0months (standard deviation 0.42). Male sex (n\u00a0= 6 studies) conferred a 2.68 (1.66\u20104.31;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt; .001) and patient age &lt;20\u00a0years (n\u00a0= 4 studies) conferred a 12.76 (5.77\u201028.2;\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001; vs &gt;20\u00a0years) increased odds of recurrence. An associated greater tuberosity fracture (n\u00a0= 7 studies) decreased the odds of recurrence by 3.8 times (2.94\u20105.00;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt; .001). The quality of evidence was moderate for age, low for sex, and very low for all other prognostic variables.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The pooled rate of recurrence after primary anterior shoulder instability was found to be 21% among moderate\u2010 to high\u2010quality prognostic studies. Male sex and younger age predicted a significantly higher risk of recurrent instability (approaching 80%), whereas concurrent fracture of the greater tuberosity significantly decreased the risk of subsequent recurrent dislocation. However, considering the quality of available evidence for these predictors, there remains a clear need for further high\u2010quality prospective studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level II, systematic review of Level I and II prognostic studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2016.05.039","type":"journal-article","created":{"date-parts":[[2016,7,31]],"date-time":"2016-07-31T15:05:17Z","timestamp":1469977517000},"page":"2616-2625","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":108,"title":["The True Recurrence Rate and Factors Predicting Recurrent Instability After Nonsurgical Management of Traumatic Primary Anterior Shoulder Dislocation: A Systematic Review"],"prefix":"10.1002","volume":"32","author":[{"given":"David 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