{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T11:58:39Z","timestamp":1793793519058,"version":"4.6.1"},"reference-count":39,"publisher":"BMJ","issue":"18","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2015,10,1]]},"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Skeletal maturity and age-related changes in the composition of the glenoid labrum and joint capsule may influence rates of recurrent instability in children. We systematically review risk factors which predispose children to recurrent shoulder instability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The systematic review-concerned studies published before May 2015. Statistical analysis was undertaken to compare rates of recurrence for each extracted risk factor. Pooled ORs were analysed using random effects meta-analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>6 retrospective cohort studies met the inclusion criteria. 8 risk factors were identified across the studies including age, sex, shoulder dominance and injury side, mechanism of injury, state of physis closure, and Hill-Sachs and Bankart lesions. The rate of recurrent instability was 73%. Children aged 14\u201318\u2005years were 24 times more likely to experience recurrent instability than children aged 13\u2005years and less (93% vs 40%; OR=24.14, 95% CI (3.71 to 156.99), Z=3.33, p=0.001, I<jats:sup>2<\/jats:sup>=6.83%). There was a non-significant trend indicating males were 3.4 times more likely to experience recurrent instability (OR=3.44, 95% CI (0.98 to 12.06), Z=1.93, p=0.053, I<jats:sup>2<\/jats:sup>=0%). Analysis of one study found that children with a closed physis are 14 times more likely to experience recurrent instability compared with those with an open physis (OR=14.0, 95% CI (1.46 to 134.25), Z=2.29, p=0.02, I<jats:sup>2<\/jats:sup>=0%) .<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Male children aged 14\u2005years and over had the greatest risk of recurrent shoulder instability following a first-time traumatic anterior shoulder dislocation. This meta-analysis summarises a mix of 6 acceptable and poor quality level III retrospective cohort studies. Further examination of this population with blinded prospective cohort studies will assist clinicians in the appropriate management of first-time traumatic anterior shoulder dislocation.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjsports-2015-095149","type":"journal-article","created":{"date-parts":[[2015,12,24]],"date-time":"2015-12-24T01:49:25Z","timestamp":1450921765000},"page":"1135-1141","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":54,"title":["In children 18 years and under, what promotes recurrent shoulder instability after traumatic anterior shoulder dislocation? A systematic review and meta-analysis of risk factors"],"prefix":"10.1136","volume":"50","author":[{"given":"M","family":"Olds","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Donaldson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Ellis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Kersten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,12,23]]},"reference":[{"key":"2024051410524884000_50.18.1135.1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20090728-34"},{"key":"2024051410524884000_50.18.1135.2","doi-asserted-by":"publisher","DOI":"10.1067\/mse.2000.108385"},{"key":"2024051410524884000_50.18.1135.3","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.2106\/00004623-199274080-00015","article-title":"The fate of traumatic anterior dislocation of the shoulder in children","volume":"74","author":"Marans","year":"1992","journal-title":"J Bone Joint Surg Am"},{"key":"2024051410524884000_50.18.1135.4","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1177\/03635465030310052001","article-title":"Traumatic anterior shoulder dislocation in adolescents","volume":"31","author":"Deitch","year":"2003","journal-title":"Am J Sports Med"},{"key":"2024051410524884000_50.18.1135.5","unstructured":"Rockwood CA , Matsen FA . The Shoulder. Fourth edition ed. Philadelphia, PA: Saunders\/Elsevier, 2009."},{"key":"2024051410524884000_50.18.1135.6","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1177\/03635465020300052401","article-title":"The unstable shoulder in the adolescent athlete","volume":"30","author":"Walton","year":"2002","journal-title":"Am J Sports Med"},{"key":"2024051410524884000_50.18.1135.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0268-0033(99)00007-8"},{"key":"2024051410524884000_50.18.1135.8","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3181ba9e7f"},{"key":"2024051410524884000_50.18.1135.9","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.89B9.18467"},{"key":"2024051410524884000_50.18.1135.10","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.E.01139"},{"key":"2024051410524884000_50.18.1135.11","doi-asserted-by":"publisher","DOI":"10.1177\/1941738109359507"},{"key":"2024051410524884000_50.18.1135.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2009.06.006"},{"key":"2024051410524884000_50.18.1135.13","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00135"},{"key":"2024051410524884000_50.18.1135.14","unstructured":"Scottish Intercollegiate Guidelines Network. 2011. http:\/\/www.sign.ac.uk\/guidelines\/fulltext\/50\/ (accessed 05 Oct 2014)."},{"key":"2024051410524884000_50.18.1135.15","doi-asserted-by":"publisher","DOI":"10.1016\/S1697-2600(13)70007-3"},{"key":"2024051410524884000_50.18.1135.16","unstructured":"Comprehensive meta-analysis version 2. [program]. Engelwood, NJ,: Biostat, 2005."},{"key":"2024051410524884000_50.18.1135.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"2024051410524884000_50.18.1135.18","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-198302000-00010"},{"key":"2024051410524884000_50.18.1135.19","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-003-1218-3"},{"key":"2024051410524884000_50.18.1135.20","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1097\/00003086-198406000-00030","article-title":"Incidence of anterior shoulder dislocation in Olmsted County, Minnesota","volume":"186","author":"Simonet","year":"1984","journal-title":"Clin Orthop Relat Res"},{"key":"2024051410524884000_50.18.1135.21","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1177\/03635465020300010501","article-title":"Predicting recurrence after primary anterior shoulder dislocation","volume":"30","author":"Kralinger","year":"2002","journal-title":"Am J Sports Med"},{"key":"2024051410524884000_50.18.1135.22","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1302\/0301-620X.86B1.13695","article-title":"The prognosis following acute primary glenohumeral dislocation","volume":"86","author":"te Slaa","year":"2004","journal-title":"J Bone Joint Surg Br"},{"key":"2024051410524884000_50.18.1135.23","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/BF00180449","article-title":"The rate of recurrence of traumatic anterior dislocation of the shoulder. A study of 154 cases and a review of the literature","volume":"17","author":"Vermeiren","year":"1993","journal-title":"Int Orthop"},{"key":"2024051410524884000_50.18.1135.24","doi-asserted-by":"publisher","DOI":"10.1007\/BF00431367"},{"key":"2024051410524884000_50.18.1135.25","first-page":"255","article-title":"Acute anterior dislocation of the shoulder: clinical and experimental studies","volume":"44","author":"Reeves","year":"1969","journal-title":"Ann R Coll Surg Engl"},{"key":"2024051410524884000_50.18.1135.26","doi-asserted-by":"crossref","first-page":"957","DOI":"10.2106\/00004623-195638050-00001","article-title":"Prognosis in dislocations of the shoulder","volume":"38","author":"Rowe","year":"1956","journal-title":"J Bone Joint Surg"},{"key":"2024051410524884000_50.18.1135.27","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6109(16)37149-3"},{"key":"2024051410524884000_50.18.1135.28","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2014-094342"},{"key":"2024051410524884000_50.18.1135.29","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.E.01327"},{"key":"2024051410524884000_50.18.1135.30","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00514"},{"key":"2024051410524884000_50.18.1135.31","doi-asserted-by":"crossref","first-page":"393","DOI":"10.2106\/00004623-198769030-00011","article-title":"Anterior dislocation of the shoulder in teen-agers and young adults. Five-year prognosis","volume":"69","author":"Hovelius","year":"1987","journal-title":"J Bone Joint Surg Am"},{"key":"2024051410524884000_50.18.1135.32","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.2106\/00004623-199611000-00006","article-title":"Primary anterior dislocation of the shoulder in young patients: a ten-year prospective study","volume":"78","author":"Hovelius","year":"1996","journal-title":"J Bone Joint Surg Am"},{"key":"2024051410524884000_50.18.1135.33","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.00261"},{"key":"2024051410524884000_50.18.1135.34","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-013-2685-2"},{"key":"2024051410524884000_50.18.1135.35","doi-asserted-by":"publisher","DOI":"10.1177\/0095399703258690"},{"key":"2024051410524884000_50.18.1135.36","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-011-9092-9"},{"key":"2024051410524884000_50.18.1135.37","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0838.2012.01494.x"},{"key":"2024051410524884000_50.18.1135.38","doi-asserted-by":"publisher","DOI":"10.3109\/17453678008990894"},{"key":"2024051410524884000_50.18.1135.39","doi-asserted-by":"publisher","DOI":"10.3109\/17453676908989501"}],"container-title":["British Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjsports-2015-095149","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T18:11:36Z","timestamp":1715710296000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjsm.bmj.com\/lookup\/doi\/10.1136\/bjsports-2015-095149"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,12,23]]},"references-count":39,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2016,9,1]]},"published-print":{"date-parts":[[2016,9]]}},"alternative-id":["10.1136\/bjsports-2015-095149"],"URL":"https:\/\/doi.org\/10.1136\/bjsports-2015-095149","relation":{},"ISSN":["0306-3674","1473-0480"],"issn-type":[{"value":"0306-3674","type":"print"},{"value":"1473-0480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,12,23]]}}}