Progression to Osteoarthritis After the Surgical Treatment of Anterior Shoulder Instability: A Systematic Review and Meta-analysis

Background: Traumatic anterior shoulder instability (ASI) is common among young, active patients, with a progression to glenohumeral osteoarthritis (OA) in up to 55% of patients. Surgical stabilization procedures are routinely offered to patients; however, the long-term risk of the development and severity of OA after these interventions remains unclear because of the overlap with injury mechanics. Purpose: To evaluate the incidence and severity of radiographic OA after surgical treatment for traumatic ASI. Study Design: Systematic review; Level of evidence, 4. Methods: This PROSPERO-registered systematic review and meta-analysis was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search was performed on February 12, 2025, in MEDLINE via PubMed, CINAHL, Embase, CENTRAL and SPORTDiscus, covering publications from 2004 to 2025. Data extracted included the rate of progression to OA (graded in accordance with the Samilson-Prieto or Buscayret classification), incidence of recurrent dislocations, and Rowe score at final follow-up. Cohort characteristics were summarized with weighted means, and data were presented as pooled proportion estimates with 95% confidence intervals (CIs), calculated via meta-analysis of binomial (OA progression, recurrent dislocation) and continuous (Rowe score) variables. Results: A total of 34 studies with a minimum 5-year follow-up comprising 2375 patients and 2403 shoulders were included, and 1962 of these shoulders had follow-up radiographs at a mean follow-up time of 139.0 months. The overall pooled rate of progression to radiographically diagnosed OA was 40.7% (95% CI, 32.6%-49.2%); rates of progression to grade ≥II and grade III OA were estimated to be 10.5% (95% CI, 6.9%-15.6%) and 2.3% (95% CI, 1.1%-4.7%), respectively. The pooled rate of OA at final follow-up based on a surgical intervention was 47.2% (95% CI, 32.0%-63.0%) for arthroscopic Bankart repair, 46.8% (95% CI, 36.6%-57.2%) for open Bankart repair, and 30.3% (95% CI, 20.0%-43.0%) for the Latarjet procedure. The overall pooled rate of recurrent instability was 10.4% (95% CI, 7.7%-13.9%), and the overall pooled Rowe score at final follow-up was 88.2 (95% CI, 86.1-90.3). Conclusion: The progression to radiographic OA occurred in a significant number of patients after surgical treatment for traumatic ASI at long-term follow-up. Although radiographic OA was common, severe degeneration was relatively rare, and functional outcomes remained favorable. These findings provide clinicians with pooled long-term data that can support evidence-based patient counseling, inform surgical planning, and guide future interventional trials.