Shoulder Ligamentoplasty, Arthroscopic Latarjet, Dynamic Anterior Stabilization, and Arthroscopic Trillat for the Treatment of Shoulder Instability: A Systematic Review of Original Studies on Surgical Techniques

Shoulder Ligamentoplasty, Arthroscopic Latarjet, Dynamic Anterior Stabilization, and Arthroscopic Trillat for the Treatment of Shoulder Instability: A Systematic Review of Original Studies on Surgical Techniques | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Shoulder Ligamentoplasty, Arthroscopic Latarjet, Dynamic Anterior Stabilization, and Arthroscopic Trillat for the Treatment of Shoulder Instability: A Systematic Review of Original Studies on Surgical Techniques Carlos Galindo-Rubín, Yehinson Barajas Ramón, Fernando Maniega-Legarda, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7563726/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Nov, 2025 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted 8 You are reading this latest preprint version Abstract Background: Anterior shoulder instability is a common condition, especially among young and active individuals, often associated with both osseous and soft tissue injuries. Recent innovations have introduced various surgical options for managing critical and subcritical instability. Therefore, he primary objective of this systematic review was to collect, synthesize, and integrate international research published across multiple scientific databases on shoulder ligamentoplasty, arthroscopic Latarjet, dynamic anterior stabilization, and arthroscopic Trillat techniques used in the treatment of shoulder instability. Method: A structured search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PICOS model, up to January 30, 2025, in the MEDLINE/PubMed, Web of Science (WOS), ScienceDirect, Cochrane Library, SciELO, EMBASE, SPORTDiscus, and Scopus databases. The risk of bias was evaluated, and the PEDro scale was used to assess methodological quality. Results: The initial search yielded a total of 964 articles. After applying the inclusion and exclusion criteria, the final sample consisted of 25 articles. These studies demonstrated a high standard of methodological quality. The review summarized the effects of ligamentoplasty, arthroscopic Latarjet, dynamic anterior stabilization, and arthroscopic Trillat techniques in treating shoulder instability, detailing the sample population, immobilization period, frequency of instability episodes—including recurrent dislocations and subluxations—surgical methods, studydesigns, assessed variables,main findings, and reported outcomes. Conclusions : Arthroscopic ligamentoplasty is advantageous in preserving the patient’s native anatomy, maintaining joint integrity, and allowing for alternative interventions in case of failure. The arthroscopic Trillat technique offers a minimally invasive solution for anterior instability without significant bone loss. The DAS technique utilizes the biceps tendon to provide dynamic stabilization, aiming to generate a sling effect over the subscapularis muscle. The Latarjet procedure remains the gold standard for managing anterior glenoid bone loss greater than 20%. Each surgical option for anterior shoulder instability carries specific implications, and treatment decisions should be tailored based on bone loss severity, capsuloligamentous quality, and the patient’s functional needs. Ligamentoplasty Arthroscopic Latarjet Dynamic Anterior Stabilization Trillat procedure Sports injuries Shoulder instability Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1. Introduction Recurrent anterior shoulder instability involves repeated glenohumeral dislocations that often require reduction maneuvers. Its estimated incidence is 1.7%, with traumatic etiology accounting for approximately 90% of cases ( 1 , 2 ). This condition significantly impairs quality of life, leading to chronic pain, functional limitations, and restrictions in daily activities ( 3 , 4 ). It is frequently associated with structural osseous and capsuloligamentous abnormalities that compromise joint stability ( 4 ). Key osseous defects include Hill-Sachs lesions, characterized by indentation of the humeral head, and anteroinferior glenoid bone loss ( 4 ). The most common capsuloligamentous injury is a Bankart lesion, involving detachment of the glenoid labrum and glenohumeral ligaments. HAGL lesions may also be present, although they are often underdiagnosed ( 4 ). A comprehensive assessment is crucial for selecting appropriate treatment, taking into account factors such as age under 25 years, history of dislocations, ligamentous laxity, muscular function, neurological conditions, and participation in high-demand activities ( 5 ). The shoulder, often compared to a large sphere resting on a small base, permits extensive motion but has limited intrinsic stability, making it particularly prone to recurrent dislocation following trauma ( 4 ). Studies indicate that 86% of primary dislocations involve glenoid bone defects, 94% are associated with Hill-Sachs lesions, and 81% present with both (bipolar lesions) ( 6 ). These injuries commonly coexist with capsulolabral damage of varying degrees, from isolated labral detachments to extensive soft tissue loss ( 7 ). Surgical treatment has advanced significantly, with arthroscopic Bankart repair now considered the standard of care for patients without significant bone loss and with stable Hill-Sachs lesions ( 8 ). However, ongoing debate surrounds the specific threshold of bone loss that warrants augmentation procedures. There is currently no universally accepted classification system for stratifying soft tissue injuries to guide surgical decision-making ( 7 ). A glenoid bone loss greater than 20% is regarded as critical and typically requires bone augmentation or reconstruction. Nonetheless, some studies suggest that bone loss as low as 13.5% may lead to suboptimal outcomes if left untreated ( 9 ). Similar challenges arise with soft tissue pathology, as both the quantity and quality of tissue influence joint stability and the feasibility of successful repair ( 10 ). For minor bone or ligamentous deficits, Bankart repair—potentially supplemented with remplissage—is the preferred approach. In contrast, when bone loss exceeds 20%, or in cases of recurrent dislocations or substantial soft tissue insufficiency, bone reconstruction techniques such as the open Latarjet or bone grafting are recommended, despite their higher complication rates ( 9 ). The main therapeutic dilemma arises in moderate bone loss cases, where the decision between Bankart with remplissage and Latarjet-type procedures remains contentious. Although both techniques demonstrate comparable recurrence rates, Latarjet procedures are associated with a higher complication rate—up to 30% in some series—and a reoperation rate of approximately 7% ( 11 , 12 , 13 ). Di Giacomo et al. ( 14 ) proposed an algorithm for treating anterior instability based on the extent of glenoid bone loss. Bone loss of less than 15% favors soft tissue repair, whereas losses between 17–25%—the so-called "gray zone"—require individualized surgical planning. Sedentary individuals or non-contact athletes may benefit from isolated arthroscopic repair. However, contact athletes tend to achieve better outcomes with glenoid reconstruction. Shaha et al. ( 9 ) introduced the concept of subcritical bone loss, showing that glenoid bone loss exceeding 13.5% results in poor functional outcomes with Bankart-only repair, even in the absence of recurrent dislocations. This finding suggests that, in active patients, soft tissue repair alone may be insufficient for long-term success. Over the past two decades, shoulder instability treatment has evolved from open surgery to advanced arthroscopic techniques. The development of arthroscopic Latarjet, Dynamic Anterior Stabilization (DAS), arthroscopic ligamentoplasty, and Trillat procedures has expanded treatment options, improving joint stability, reducing complications, and optimizing recovery ( 15 , 16 ). These techniques bridge the gap between open surgery—which offers greater stability but carries a higher risk of complications—and conventional arthroscopic repairs, which are less invasive but may have higher recurrence rates in subcritical bone loss cases. They offer personalized, hybrid solutions that optimize clinical outcomes while minimizing surgical risks ( 15 , 16 ). Among these, arthroscopic Latarjet has been validated ( 17 ) as a reliable technique, involving the transfer of the coracoid process and conjoint tendon through the subscapularis to the anteroinferior glenoid, thereby restoring bone loss and enhancing dynamic stability via a sling effect. The arthroscopic approach improves graft positioning, facilitates concurrent soft tissue repair, and reduces morbidity and recovery time compared to open procedures. The stabilization mechanism combines a bony block effect that extends the glenoid articular arc, a dynamic sling effect from the subscapularis–conjoint tendon complex, and capsular reinforcement through attachment to the residual coracoacromial ligament ( 17 ). Another validated method is arthroscopic ligamentoplasty ( 18 ), where a polyester graft or allograft is anchored sublabral at the anteroinferior glenoid and extended through or over the subscapularis to the proximal humerus, reinforcing anterior capsular stability. Similarly, the arthroscopic Trillat procedure ( 19 , 20 ) modifies the position of the coracoid to reduce the subcoracoid space, optimizing tension in the conjoint tendon to enhance anterior shoulder stability. Dynamic Anterior Stabilization (DAS) ( 21 ) involves transferring the biceps tendon to the anterior glenoid, mimicking the sling effect and providing dynamic stabilization via a less invasive technique. Currently, no Level 1A studies directly compare these surgical techniques for treating shoulder instability. However, existing evidence suggests that their outcomes are comparable, supporting their role as viable alternatives in managing severe instability. Therefore, the main aim of this systematic review was to collect, synthesize, and integrate international research published across various scientific databases on shoulder ligamentoplasty, arthroscopic Latarjet, dynamic anterior stabilization, and arthroscopic Trillat techniques for the treatment of shoulder instability. This way, this review determines the current state of the knowledge about this topic and allows a better understanding of the existing problems, making easier the development of future lines of research. 2. Methods 2.1. Searching strategies and sources of information This article presents a systematic review focused on surgical techniques for the treatment of recurrent anterior shoulder instability. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA®) guidelines ( 22 ), ensuring methodological integrity. The review was registered in PROSPERO (ID =). Methodological issues were addressed using the guidance provided by the Cochrane Handbook for Systematic Reviews of Interventions ( 23 ). The PICOS® model was used to define the inclusion criteria ( 24 ): P (Population): "patients with recurrent shoulder instability," I (Intervention): "shoulder stabilization surgery," C (Comparators): "comparison groups of multidisciplinary interventions," O (Outcome): "shoulder mobility, dislocation rate, return-to-play (RTP) rate, pain," and S (Study design): "any study design" (Fig. 1 ). A structured search was conducted in MEDLINE/PubMed, Web of Science (WOS), ScienceDirect, Cochrane Library, SciELO, EMBASE, SPORTDiscus, and Scopus. The search was completed on January 30, 2025. Search terms included a combination of Medical Subject Headings (MeSH) and free-text keywords related to concepts such as shoulder instability, surgical techniques, and arthroscopic procedures. Specifically, the following search equation was used: [" shoulder instability " (MeSH Terms) OR " shoulder dislocation " (All Fields)] AND [" Latarjet outcomes "] AND [" Dynamic Anterior Stabilization Shoulder " (MeSH Terms)] AND [" Trillat Shoulder " (MeSH Terms)] AND [" Shoulder Ligamentoplasty " (MeSH Terms)]. This searches equation retrieved all relevant articles in the field. Additionally, the reference sections of the included articles were examined using the "snowballing method" ( 25 ), which involves reviewing the citations within retrieved studies. All titles and abstracts from the search were screened to identify duplicates and any potentially missing studies (C.G.-R. and A.V.-S). Titles and abstracts were selected for full-text review. The search for published studies was conducted independently by two different authors (C.G.-R. and A.V.-S), and any disagreements were resolved through discussion between them. 2.2. Inclusion and Exclusion Criteria Studies reporting effectiveness outcomes in terms of diagnostic accuracy or performance related to the surgical management of shoulder instability were selected. The systematic review included original studies on surgical techniques for treating severe shoulder instability. Systematic reviews, meta-analyses, conference abstracts, opinion pieces, and posters were excluded. Only studies with a minimum sample size of 10 participants were included. For effectiveness studies, only those that employed at least one arthroscopic shoulder stabilization technique were considered. The surgical techniques examined for comparison included arthroscopic Latarjet, arthroscopic Trillat, Dynamic Anterior Stabilization, and shoulder ligamentoplasty. For the articles retrieved during the search, the following inclusion criteria were applied to the final selection: (I) studies published in peer-reviewed journals with full-text availability; (II) articles analyzing the effects of stabilization surgeries in patients with shoulder instability; (III) original research articles published in peer-reviewed journals with an impact factor; (IV) studies involving patients treated with arthroscopic Latarjet, arthroscopic Trillat, Dynamic Anterior Stabilization, or shoulder ligamentoplasty; (V) study populations consisting of patients who underwent arthroscopic techniques for the treatment of recurrent shoulder instability; (VI) studies that included preoperative and/or postoperative clinical evaluations; (VII) studies published in English and/or Spanish. The following exclusion criteria were applied to experimental research protocols: (I) lack of reliable measurements; (II) studies with fewer than 10 participants; (III) use of open surgical techniques; (IV) fixation methods involving metal buttons or staples; (V) abstracts, non-peer-reviewed articles, and book chapters. 2.3. Study Selection Titles and abstracts of publications identified through the search strategy were reviewed for full-text selection and cross-checked to eliminate duplicates. All studies assessed for eligibility and classified as relevant were retrieved, and their full texts were peer-reviewed by two authors (C.G.-R. and A.V.-S). Additionally, the reference sections of all relevant articles were examined using the snowballing strategy ( 25 ). Based on the information provided in the full-text articles, inclusion and exclusion criteria were applied to select eligible studies for inclusion in this systematic review. Any disagreements were resolved through discussion between the two authors (C.G.-R. and A.V.-S). 2.4. Data Extraction Once the inclusion and exclusion criteria were applied to each study, the following data were extracted: study source (author(s) and year of publication); sample population, including number of participants; weeks of immobilization; recurrence or dislocation rate; surgical technique used; type of study design; variables analyzed; results and conclusions; and intervention effects. For each study, information was carefully collected from all eligible publications. Mean (±), standard deviation (SD), and sample size data were extracted from the tables of all included studies. Disagreements were subsequently resolved through discussion until consensus was reached. 2.5. Quality assessment and Risk of Bias Methodological quality and risk of bias were assessed independently by two authors (C.G.-R. and A.V.-S), with any disagreements resolved by a third reviewer (J.C.-G), in accordance with the Cochrane Collaboration Guidelines ( 26 ). The Cochrane Risk of Bias tool included the following domains: ( 1 ) selection bias (random sequence generation, allocation concealment), ( 2 ) performance bias (blinding of participants and personnel), ( 3 ) detection bias (blinding of outcome assessment), ( 4 ) attrition bias (incomplete outcome data), ( 5 ) information bias (selective reporting), and ( 6 ) other sources of bias. For each investigation, the criteria were shown as "low" if the criteria were met for low-risk bias (unlikely to seriously alter the results) or "high" if the criteria were for high-risk bias (seriously undermining the reliability of the results). If the risk of bias was unknown, it was considered "unclear" (it casts doubt on the results). The systematic review followed the principles of the PRISMA® statement ( 22 ), a checklist designed to ensure transparency in systematic reviews and to improve their scientific credibility. PRISMA® includes 27 items and a flow chart with four stages, which includes items considered essential for the transparent communication of a systematic analysis. The Physiotherapy Evidence Database (PEDro) scale was also used to assess the methodological quality of all selected studies. This scale is a commonly used tool in literature reviews and is designed to evaluate the quality of clinical trial designs (Table 1 ). It is based on a list developed by Verhagen ( 27 ) using the Delphi technique ( 28 ). Table 1 "Physiotherapy Evidence Database (PEDro) scale to analyze the methodological quality of the studies". PEDro scale 1 The selection criteria were specified Yes No 2 The subjects were randomly assigned to the groups Yes No 3 The allocations were undisclosed Yes No 4 The groups were similar at baseline in relation to the indicators of prognosis Yes No 5 All subjects were blinded Yes No 6 All the sports scientists providing therapy were blinded Yes No 7 All assessors evaluating at least one of key results were blinded Yes No 8 All the measures of at least one of the key results were obtained from more than 85% of the subjects initially assigned to the groups Yes No 9 The results of all the subjects receiving treatment or assigned to the control group were given, or when not possible, the data for at least one key result were analyzed "in order to treat" Yes No 10 The results of statistical comparisons among groups were reported for at least one key result Yes No 11 The study provides specific and variability measures for at least one key result Yes No The PEDro scale has a total of 11 items. Item 1 refers to the external validity of the study, while items 2–9 refer to internal validity. Items 10 and 11 indicate whether the statistical information provided by the authors allows for accurate interpretation of the results. All items on the list are dichotomized as "yes", "no", or "not reported". Each item marked "yes" receives one point, while items marked "no" or "not reported" receive no points. The first item of the PEDro scale was not considered in this review, as it relates to the evaluation of external validity. Therefore, only items 2 through 11 were used to assess methodological quality. As a result, the maximum possible score for an article was 10 points, and the minimum possible score was 0. The evaluation of heterogeneity was another aspect considered in the review. Clinical heterogeneity refers to differences among types of patients, treatments, and outcomes. Methodological heterogeneity refers to variability in study designs and bias control. 3. Results 3.1. Main Search The database search identified 963 publications. Of the 963 articles retrieved, 16 were excluded given that they were duplicates. A digital screening of sources generated 807 relevant studies, which were included for review. After a detailed review of titles, abstracts, and full texts, 64 publications met the inclusion criteria. Subsequently, 40 articles were excluded for not addressing the surgical techniques under review or for being editorials, surgical technique descriptions, citations, reviews, posters, commentaries, or comparative studies. Studies involving epileptic patients were also excluded. From the final selection, 25 studies were included in the systematic review. Seven articles contained significant data on the arthroscopic Trillat technique [( 29 ), ( 30 ), ( 31 ), ( 32 ), ( 33 ), ( 34 ), ( 35 )]. Four articles reported significant findings related to the Dynamic Anterior Stabilization technique [( 36 ), ( 37 ), ( 38 ), ( 39 )]. Three articles presented relevant data on anterior shoulder ligamentoplasty [( 40 ), ( 18 ), ( 41 )]. Eleven articles provided significant information on the arthroscopic Latarjet technique [( 42 ), ( 43 ), ( 44 ), ( 45 ), ( 46 ), ( 47 ), ( 48 ), ( 49 ), ( 50 ), ( 51 ), ( 52 )] (Fig. 2 ). 3.2. Study Characteristics The source of each study (author and year of publication), immobilization time, number of episodes of instability including recurrent dislocations and subluxations, surgical technique, type of study design, study variables, main findings, and the effects of the intervention are summarized in Table 2 . A total of 25 original articles were included with significant data related to the arthroscopic techniques analyzed, specifically Trillat, Dynamic Anterior Stabilization (DAS), arthroscopic Latarjet, and shoulder ligamentoplasty procedures. Table 2 Methodology and results of the interventions. Study N Time Eps. Surgical technique Design Variables Main Findings Effects Labattut et al. ( 29 ) 18 4 wks 1 Arthroscopic Trillat 1 screw Retrospective descriptive (at least 1 year follow-up) Walch-Duplay score Rowe score External rotation loss Patient satisfaction Positive lift-off test Intra-operative complications Satisfactory short- and mid-term stability, simple procedure, short operative time, no specific complications. → Gonnachon et al. ( 30 ) 58 4 wks no info Arthroscopic Trillat Single center, retrospective study. Morphological parameters were measured on all the rotator cuff muscles: cross sectional area (CSA), thickness and fatty infiltration using the mean muscle attenuation (MMA) measurement. Isokinetic tests were done 1 year post-surgery Minor subscapularis atrophy at 6 months, no strength deficit at 1 year, likely screw-related ↑ Chauvet et al. ( 31 ) 52 3 wks 2 (3.8%) Arthroscopic Trillat retrospective Constant Rowe Walch-Duplay subjective shouldervalue shoulder range of motion xRay Good outcomes for chronic anterior instability; not recommended for > 20% glenoid loss. ↑ Kazum et al ( 32 ) 19 ?? 0 (o%) Arthroscopic Trillat retrospective review Constant-Murley Walch-Duplay ROWE Subjective Shoulder Value (SSV) Visual Analogue Scale (VAS). Post-operatively, healing of the coracoid osteoclatsy was evaluated by CT scan. Effective for recurrent instability and apprehension in anterior/inferior hyperlaxity Boileau et al ( 33 ) 30 4 wks 3 (10%) Arthroscopic Trillat technique retrospective evaluation of patients x-rays computed tomography scans Subjective Shoulder Value visual analog scale Walch Constant Rowe Effective for young athletes with hyperlaxity and no major bone loss; enables return to sports. ↑ Boileau et al. ( 34 ) 21 4 wks 1 (4%) Arthroscopic Trillat technique Twenty-one consecutive patients retrospectively reviewed. x-rays computed tomography scan Subjective Shoulder Value visual analog scale Walch Constant Rowe Durable option for recurrent dislocations in older patients with chronic MIRCTs and preserved motion. ↑ Moore et al. ( 35 ) 74 3 wks 3 (4.1%) Arthroscopic Trillat technique Multicenter retrospective study Dislocation recurrence. Subluxation recurrence Functional outcomes Time and level of return to sport Bony fusion complications. Constant Rowe Walch Duplay Shoulder Subjective Value Highly effective for athletes with chronic instability; enables rapid return to sport. ↑ De Campos et al. ( 36 ) 15 3 wks 1 (6.7%) Arthroscopic DAS unicentric single-arm prospective study Western Ontario Shoulder Instability Index Rowe score range of motion strength ability to return to play at same level lack of recurrence of instability successful LHB healing lack of complications. DAS improves function, ensures LHB healing, and is safe for AGI with 20% GBL. ↑ Collin et al. ( 37 ) 22 1.5 wk (10d) 3 (13.6%) Arthroscopic DAS A retrospective evaluation Rowe score range of motion (ROM) recurrence. DAS supports Bankart repair in subcritical bone loss; preserves ROM, no Popeye deformity. ↑ Wu et al. ( 38 ) 63 6 wks 0 (o%) Arthroscopic DAS retrospective cohort study patient-reported outcomes range of motion return to sports (RTS) Postoperative recurrent instability complications DAS-LHB and DAS-CT show similar recurrence, complications, STR, and function → De Campos et al. ( 39 ) 3 3 wks 0 (0%) Arthroscopic DAS single-arm prospective study FF Abd E R IR WOSI RoweScore Shoulder Abduction Strength (kg) Significant improvement in WOSI and Rowe scores (above MCID). MRI: Successful LHB tendon healing at glenoid ↑ Cuellar et al. ( 40 ) 52 1 wk 3 (5.8%) Arthroscopic ligamentoplasty retrospective descriptive study Constant-Murley Score, subjective outcomes, radiographic control, ROM, apprehension signs, relocation tests, and shoulder laxity (anterior, posterior, inferior 'sulcus' tests) 59.6% excellent outcomes with no pain, full mobility and return to sports; 90% patient satisfaction. → Sanchez et al. ( 41 ) 110 1 wk 2 (1.8%) Arthroscopic ligamentoplasty retrospective descriptive study Constant score Safe arthroscopic technique with good results ↑ Sánchez et al.( 42 ) 168 1 wk 6 (3.57%) Arthroscopic ligamentoplasty multicenter retrospective study Constant score degree of subjective satisfaction Stability mobility pain RTP reoperation complications. Good objective and subjective outcomes. This technique expands stabilizing surgical options ↑ Descamps et al. ( 43 ) 68 4 wks 4 (6%) Arthroscopic Latarjet Procedure with Button Fixation Single-Center Retrospective Study Radiography (RX) Computed Tomography (CT) Rowe Score Age Sex Hyperlaxity ISIS Score Sports Bilateral Instability Previous Failed Soft Tissue Surgery Smoking Status Glenoid Bone Loss, Hill-Sachs Lesion Safe, durable for recurrent instability; high RTS, minimal OA; suture button lowers complications vs screws. → Dumont et al. ( 44 ) 64 1 wk 1 (1.5%) Arthroscopic Latarjet procedure Clinical retrospective study. Dislocations, subluxations, reoperations, WOSI score, and 15% complication rate in 64 patients Low recurrence; better than Bankart, comparable to open Latarjet; reliable but technically demanding ↑ Boileau et al. ( 45 ) 47 4 wks 0 (0%) Arthroscopic Latarjet procedure Forty-seven consecutive patients Level of Evidence: Level IV, therapeutic case series. Rowe Walch Duplay recurrence mobility stability RTS (return to sport) pain X-ray CT scan Reproducible, safe, with good cosmetic and functional outcomes. → Mouchanta et al. ( 46 ) 73 3 wks 5 (7%) Arthroscopic Latarjet procedure A multicenter retrospective study RTS, time to rugby practice, athletic level, patient satisfaction, recurrence, apprehension, SSV (subjective shoulder value), 3-month CT scan Effective for rugby players; high RTP, low recurrence, high patient satisfaction. → Meraner et al. ( 47 ) 132 0 wks 8 (6.1%) Arthroscopic Latarjet procedure A total of 132 shoulders retrospective study. The aim of this study is to evaluate the clinical outcomes and complications of the procedure, with a particular focus on the infection rate and nerve damage. The DASH questionnaire was completed by 60% of the patients. Reliable for shoulder instability; prevents chronic luxation with low recurrence. → Pelletier et al. ( 48 ) 40 3 wks 3 (7.5%) Arthroscopic Cortical-Button Latarjet Procedure This is a monocentric retrospective study including 40 patients active range of motion apprehension test Rowe Walch-Duplay Subjective Shoulder Value Net Promoter Score. Radiologically, evolution of the bone graft and degenerative arthritis of the shoulder 95% RTP, 7.5% recurrence, 16% apprehension, 19% GH osteoarthritis, high satisfaction ↑ Tadeu et al. ( 49 ) 26 2 wks 0 (0%) Arthroscopic Latarjet procedure with endobuttons Methods: A retrospective study of 26 patients DASH UCLA Rowe Visual Analog Scale (VAS) Short-Form 36 (SF36) Correct position and consolidation of the graft were evaluated. Effective, safe, good functional outcomes, enables early rehabilitation → Shao et al. ( 50 ) 425 ?¿ 1,50% Arthroscopic Bristow versus Latarjet with screws or buttons A prospective longitudinal Recurrent dislocation, subluxation, and infections led to reoperations. Complications: 27.1% in Bristow, 25.6% in Latarjet, mainly graft-related (11.7%) and neurological (10.7%). Suture-button Bristow has fewer complications than screw fixation ↓ Brzoska et at. ( 51 ) 46 4 wks 4 (8.7%) Arthroscopic Latarjet procedure Study Design: Case series; Level of evidence, 4. 50 months Sport activity assessed via KJOC, RTS score, Constant-Murley, Walch-Duplay, ROM, complications, recurrence, and revisions 95.7% RTS after arthroscopic Latarjet, with occasional complications → Shao et al. ( 52 ) 30 4–6 wks 0 (0%) Arthroscopic Latarjet procedure with modified button fixation Retrospective study UCLA ASES Rowe Radiologic assessment on 3D CT scan was performed preoperatively and postoperatively. Compli cations were also recorded. Modified suture-button Latarjet ensures stable fixation, good outcomes, low complications, and bone remodeling. ↓ Zeng et al. ( 53 ) 37 4 wks 0 (0%) Arthroscopic Latarjet procedure Retrospective study Walch-Duplay, SSV, Rowe, AROM, and 3D CT assessed graft position and bone resorption. Arthroscopic Latarjet + capsular repair shows good short-term outcomes; long-term effects need further study. → ↑: positive effect; →: no effect; ↓: negative effect; N: sample; IMT: immobilization time; EI: episodes of instability, including recurrent dislocations and subluxations. STechnique: surgical technique; SD: study design; V: variables; MR: Main results; EF: effect 3.3. Risk of Bias The methodological quality and the risk of bias were evaluated following the guidelines of the Cochrane Collaboration ( 26 ). For each investigation, the criteria were rated as "low" if they were met for a low risk of bias (unlikely to severely alter the results), or "high" if they indicated a high risk of bias (significantly weakening the reliability of the results). If the risk of bias was unknown, it was considered "not clear" (indicating uncertainty about the results). Every included study was assessed for the risk of bias ( 26 ). The full assessments of study quality are shown in Figs. 3 and 4 . 3.4. Methodological Quality Assessment The methodological quality of the included and analyzed studies ranged from 3 to 9 points, with an average of 6.92 points. The distribution was as follows: 1 study scored 3 points, 4 studies scored 5 points, 2 studies scored 6 points, 7 studies scored 7 points, 10 studies scored 8 points, and 1 study scored 9 points. Despite some variation in item scores, there was notable consistency in certain criteria that were clearly met across studies. Specifically, item 4 ("the groups were similar at baseline in relation to the indicators of prognosis"), item 10 ("the study provides specific and variability measures for at least one key result"), and item 11 ("the results of statistical comparisons among groups were reported for at least one key result") were consistently fulfilled. Conversely, none of the studies met item 3 ("the allocations were undisclosed"). Finally, one study met all quality criteria except for item 3 (Table 3 ). Table 3 Results according to PEDro scale (n = 25). Clinical trial 1 2 3 4 5 6 7 8 9 10 11 Total Labattut et al. ( 29 ) Yes No No Yes Yes Yes No Yes Yes Yes Yes 7 Gonnachon et al. ( 30 ) Yes No No Yes No No No Yes Yes Yes Yes 5 Chauvet et al. ( 31 ) Yes No No Yes Yes Yes No Yes Yes Yes Yes 7 Kazum et al. ( 32 ) Yes No No Yes Yes Yes No Yes Yes Yes Yes 7 Boileau et al. ( 33 ) Yes No No Yes Yes Yes No Yes Yes Yes Yes 7 Boileau et al. ( 34 ) Yes No No Yes Yes Yes No Yes Yes Yes Yes 7 Moore et al. ( 35 ) Yes Yes No Yes Yes Yes No Yes Yes Yes Yes 8 De Campos et al. ( 36 ) Yes No No Yes Yes Yes Yes No No Yes Yes 6 Collin et al. ( 37 ) Yes No No Yes No No No Yes Yes Yes Yes 5 Wu et al ( 38 ) Yes No No Yes No No No Yes Yes Yes Yes 5 De Campos et al. ( 39 ) Yes No No Yes No No No No No Yes Yes 3 Cuellar et al. ( 40 ) Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes 9 Sanchez et al. ( 41 ) Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 8 Sanchez et al. ( 42 ) Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 8 Descamps et al. ( 43 ) Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 8 Guillaume et al. ( 44 ) Yes Yes No Yes No No No Yes Yes Yes Yes 6 Boileau et al. ( 45 ) Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 8 Mouchant et al. ( 46 ) Yes Yes No Yes Yes Yes No Yes Yes Yes Yes 8 Meraner et al. ( 47 ) Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 8 Pelletier et al. ( 48 ) Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 8 Nascimento et al. ( 49 ) Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 8 Shao et al. ( 50 ) Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 8 Brzoska et al. ( 51 ) Yes No No Yes Yes Yes No Yes Yes Yes Yes 7 Shao et al. ( 52 ) Yes No No Yes No No No Yes Yes Yes Yes 5 Zeng et al. ( 53 ) Yes No No Yes Yes Yes No Yes Yes Yes Yes 7 Yes: it presents the studied criterium. No: it does not present the studied criterium. 1. The criteria of election were specified; 2. The subjects were randomly assigned to the groups; 3. The assignment was hidden; 4. The groups were similar at the beginning in relation to the most important indicators of prognosis; 5. All participants were blinded; 6. All the sports scientists providing therapy were blinded; 7. All assessors evaluating at least one of key results were blinded; 8. All the measures of at least one of the key results were obtained from more than 85% of the participants initially assigned to the groups; 9. The results of all the subjects receiving treatment or assigned to the control group were given, or when not possible, the data for at least one key result were analysed “in order to treat”; 10. The results of statistic comparisons among groups were reported for at least one key result; 11. The study provides specific and variability measures for at least one key result. With regard to the chronology of the 25 articles studied (Fig. 5 ), 13 have been published in the last 17 years; 6 in 2024 ( 30 , 35 , 43 , 46 , 48 , 50 ); 4 in 2023 ( 34 , 36 , 38 , 51 ); 5 in 2022 ( 31 , 32 , 33 , 37 , 52 ); and 2 in 2021 ( 39 , 53 ). The remaining research corresponds to 8 studies, which are divided into 1 in 2019 ( 47 ); 2 in 2018 ( 29 , 49 ); 1 in 2014 ( 44 ); and finally, 4 prior to 2010 ( 45 , 42 , 40 , 41 ). The above shows the great interest and importance of use of surgical techniques for the treatment of shoulder instability. The reviewed studies highlight the clinical utility of these arthroscopic techniques, each offering specific benefits based on patient anatomy and functional needs. The overall evidence supports the effectiveness and safety of these ones. Each technique offers distinct advantages based on anatomical deficits and functional demands, emphasizing the need for personalized surgical planning in the management of anterior shoulder instability. All the above information is summarized in the following Table 4 : Table 4 Summary of surgical techniques for treating shoulder instability Nº Studies Thematic Conclusion 4 Dynamic Anterior Stabilization (DAS) This technique would be indicated mainly in patients with recurrent shoulder instability and bone defects of less than 10% 11 Arthroscopic Latarjet The technique is especially relevant when unipolar bone loss exceeds 20% of the glenoid surface, notably when associated with humeral bone loss in the form of an off-track Hill-Sachs lesion. 3 Arthroscopic Ligamentoplasty Its primary indication would be in patients with high functional demand and multi-recurrent instability, particularly in those with poor or suboptimal capsuloligamentous tissue quality. 7 Arthroscopic Trillat It is particularly suited for cases in which the surgeon aims to achieve a tenodesis effect on the subscapularis without altering the anatomy of the subscapularis or other soft tissues. 4. Discussion 4.1. Summary of Main Findings The main aim of this of this systematic review was to collect, synthesize, and integrate international research published across various scientific databases on surgical techniques such as shoulder ligamentoplasty, arthroscopic Latarjet, dynamic anterior stabilization, and arthroscopic Trillat for the treatment of shoulder instability. Anterior shoulder instability is a common condition affecting both the general population and athletes, and represents one of the most frequent causes of functional limitation in the upper limb. Its pathophysiology is based on an imbalance between the dynamic and static stabilizers of the glenohumeral joint, predisposing individuals to recurrent episodes of dislocation and subluxation. This condition, in addition to causing pain and disability, increases the risk of progressive joint deterioration and the development of glenohumeral arthropathy, reinforcing the need for effective and personalized therapeutic intervention ( 4 , 53 ). The surgical treatment of anterior instability has evolved significantly over recent decades, transitioning from highly invasive open procedures to advanced arthroscopic techniques aimed at maximizing joint stability while minimizing tissue damage ( 54 ). Among the most widely used and studied techniques are Dynamic Anterior Stabilization (DAS), arthroscopic Latarjet, arthroscopic ligamentoplasty, and arthroscopic Trillat. These techniques have proven effective in different patient subgroups depending on the specific characteristics of their instability, the presence of bone deficits, and the quality of the capsuloligamentous tissue ( 17 , 18 , 19 , 20 ). These four techniques share the ability to achieve satisfactory outcomes in patients whose instability is influenced by both osseous and soft tissue risk factors. However, a key difference lies in the fact that ligamentoplasty is the only technique that does not alter the patient’s anatomy. It involves the repair of all possible structures, the potential execution of a remplissage to address humeral bone defects, and the addition of a ligamentous graft that does not modify the anatomy but acts as an adjunct to the patient’s natural structures. This also prevents glenohumeral dislocation in cases where abduction and external rotation are extreme enough for the humeral head to dislocate anteroinferiorly on the scapular glenoid ( 17 ). This anatomical preservation is not present in DAS, Trillat, or arthroscopic Latarjet, establishing a significant distinction among these techniques. In the latter three, the anatomy is altered to enhance stabilization, and although the objective is effectively achieved, this factor is not without risks or potential future complications ( 17 , 18 , 19 , 20 ). These must be carefully considered when determining the best surgical approach for each patient, particularly given that the target population is composed of young and active individuals. The indicated measures were verified in terms of efficiency in the different studies analyzed in this review. There currently exist many literary proposals which attempt to consolidate these techniques in terms of prevention protocols, studying their effects in a complex manner. In spite of this, it was observed that preventive actions are not currently implemented systematically. Therefore, the current scientific literature describes different surgical approaches that aim to balance anatomical preservation, joint stability, and functional recovery (Fig. 6 ). However, there is a clear need for more robust comparative data, particularly through randomized controlled trials, to guide optimal technique selection. This systematic review seeks to address this gap by providing a comprehensive analysis of the available evidence, helping clinicians better understand the indications, outcomes, and limitations of each arthroscopic technique used in the management of anterior shoulder instability. 4.2. Dynamic Anterior Stabilization (DAS) The DAS technique has recently emerged as a less invasive alternative for shoulder stabilization in patients with anterior instability and subcritical bone loss. Its biomechanical principle involves transferring the long head of the biceps tendon through the subscapularis to create a sling effect that enhances joint stability under anterior stress. Unlike other techniques focused on osseous or capsular reconstruction, DAS utilizes the biceps' dynamic stabilizing function to provide active control of humeral translation ( 18 ). Recent studies ( 39 , 18 , 38 ) have shown promising results with this technique. Clara de Campos Azevedo et al. ( 39 ) reported a significant reduction in recurrence rates and considerable improvement in postoperative functional scores in patients with subcritical instability treated with DAS. Similarly, Collin et al. ( 18 ) found that this technique preserves the range of motion without compromising shoulder function, offering a key advantage over more invasive procedures. Wu et al. ( 38 ) observed comparable return-to-sport rates between DAS and other traditional techniques, highlighting its effectiveness in postoperative rehabilitation. However, DAS still presents certain challenges and limitations. Its indication is restricted to patients with mild to moderate bone loss, as its stabilizing effect may be insufficient in cases of critical bone loss. Additionally, the long-term clinical outcomes remain uncertain and under evaluation, requiring further data collection to determine its efficacy compared to more established techniques ( 36 ). This technique would be indicated mainly in patients with recurrent shoulder instability and bone defects of less than 10%, particularly when associated with pathology of the bicep’s tendon or its superior glenoid insertion, and when the goal is to address both conditions while adding a tenodesis effect or sling effect to the subscapularis tendon. 4.3. Arthroscopic Latarjet Arthroscopic Latarjet is one of the most widely used techniques for treating anterior instability with critical bone loss. It involves the transfer of the coracoid process along with the conjoint tendon to the anteroinferior region of the glenoid, providing a dual stabilizing effect: the bone block increases contact surface area and prevents excessive humeral translation, while the tension generated by the conjoint tendon acts as a dynamic stabilizing mechanism ( 17 ). Recent studies ( 42 , 43 , 44 ) have confirmed the effectiveness of arthroscopic Latarjet in preventing recurrence. Descamps et al. ( 42 ) reported that suture fixation instead of screws significantly reduced postoperative complications related to graft migration, osteolysis, and consolidation defects, improving procedural safety. Dumont et al. ( 43 ) demonstrated that the recurrence rate following surgery is low and comparable to that of open Latarjet, with the additional advantage of reduced surgical aggression and shorter recovery time. Boileau et al. ( 44 ) highlighted that this procedure is not only safe and reproducible but also offers superior aesthetic and functional outcomes compared to open techniques. Despite these benefits, arthroscopic Latarjet remains technically demanding. It requires a high level of surgical expertise. Additionally, patient selection must be meticulous, as graft resorption, hardware-related complications, and glenohumeral arthropathy may present long-term challenges ( 45 ). This technique, although effective, is not without complications. These may include potential neurological sequelae, especially in patients undergoing revision surgery or presenting with recurrent instability following prior treatments. It is particularly indicated in cases of severe, recurrent instability with extensive capsular and labral damage. The technique is especially relevant when unipolar bone loss exceeds 20% of the glenoid surface, notably when associated with humeral bone loss in the form of an off-track Hill-Sachs lesion. It is a technique that alters the native anatomy and, although highly effective, offers few clear alternative options in the event of failure. This is particularly critical when the joint is already compromised by both the initial instability and the consequences of the procedure or its failure. Therefore, except in selected cases, it should be considered a second-line treatment option. 4.4. Arthroscopic Ligamentoplasty Arthroscopic ligamentoplasty represents an intermediate surgical option between conventional capsulolabral repair and bone reconstruction techniques in the management of anterior shoulder instability. This technique aims to enhance capsular stabilization through the fixation of a synthetic or biological ligament graft. It increases resistance to humeral head translation while preserving joint mobility. It is the only one of the four techniques that does not alter the patient’s native anatomy. The procedure maintains bony integrity, reconstructs the capsuloligamentous structures, and adds mechanical support through the graft itself ( 18 , 55 ). Clinical studies ( 18 , 43 , 56 ) have demonstrated the potential benefits of arthroscopic ligamentoplasty. Cuéllar Gutiérrez et al. ( 18 ) reported favorable clinical outcomes in patients with recurrent anterior instability without significant bone loss, achieving a 90% satisfaction rate. These findings were supported by Sánchez et al., who described effective functional recovery and minimal postoperative morbidity in patients treated with synthetic anterior capsular reinforcement ( 18 , 43 ). Collectively, these results suggest that arthroscopic ligamentoplasty may be a safe and effective surgical option in selected patients. It expands the range of techniques available for shoulder stabilization. However, the role of arthroscopic ligamentoplasty remains a subject of ongoing discussion within the orthopedic community. One of the primary concerns is the variability in graft integration, which may influence the long-term success and mechanical reliability of the procedure. While short- and mid-term results appear promising, further studies are warranted to assess long-term durability, outcomes, and complications, particularly regarding graft behavior over time ( 57 ). Arthroscopic ligamentoplasty offers a distinct approach to shoulder stabilization by reinforcing the capsular structures without altering the native anatomy. Clinical data support its ability to achieve satisfactory functional recovery and high patient satisfaction in properly selected cases ( 40 , 41 ). Nevertheless, the long-term performance of the technique and the biological behavior of the graft require continued investigation to more clearly define its role in the surgical management of shoulder instability. This technique should be more widely adopted. Its primary indication would be in patients with high functional demand and multi-recurrent instability, particularly in those with poor or suboptimal capsuloligamentous tissue quality. It is also indicated in cases of subcritical glenoid bone loss of less than 20%. This technique enables soft tissue repair where feasible and adds both a tenodesis and sling effect to the subscapularis without altering the patient's native anatomy, as the ligament can be placed either through the subscapularis tendon or above its superior border. The implants used have minimal impact on bone stock. The procedure reinforces the anterior capsule and ligaments by introducing a controlled block to extreme external rotation and abduction. All of this is achieved through a fully arthroscopic approach. Alternatively, it may be performed with a minimal axillary incision when the mini-invasive humeral fixation technique is chosen. Moreover, if the surgeon prefers to avoid the use of synthetic grafts due to concerns regarding their healing potential, the technique allows for the use of either an allograft or a tendon autograft. Therefore, it represents our treatment of choice in cases of severe instability in active patients with subcritical bone loss and compromised soft tissue quality. 4.5. Arthroscopic Trillat The arthroscopic Trillat technique is a minimally invasive and promising surgical option for the treatment of anterior shoulder instability in selected patients without significant bone loss. This procedure involves an arthroscopic coracoid osteotomy to reposition the coracoid process, thereby reducing the subcoracoid space and increasing tension on the conjoint tendon. This biomechanical modification helps limit humeral head translation and enhances joint stability ( 29 ). Clinical studies ( 31 , 32 , 35 ) have reported positive outcomes, particularly in patients with hyperlaxity or chronic post-traumatic anterior instability. Labattut et al. ( 29 ) demonstrated satisfactory short- and mid-term outcomes with a low complication profile, minimal surgical time, and early return to activity. Chauvet et al. ( 30 ) confirmed these results with a two-year follow-up, showing sustained shoulder stability and functional recovery. Boileau et al. ( 34 ) further highlighted the effectiveness of the technique in two distinct populations: young athletes with hyperlaxity and older patients with recurrent dislocations and massive irreparable rotator cuff tears (MIRCTs) ( 33 ). The main indications for this technique include recurrent anterior instability in the absence of significant glenoid or humeral bone defects, especially in patients with hyperlaxity. Arthroscopy provides superior visualization of the glenohumeral joint, allowing accurate coracoid osteotomy and secure fixation. The outcomes are encouraging, with improved shoulder stability and low recurrence rates. Kazum et al. ( 32 ) found the procedure effective for anterior/inferior hyperlaxity, with minimal postoperative complications. Moore et al. ( 58 ) also reported high functional scores and rapid return to sports in a multicenter study involving athletic populations. Regarding complications, the technique is generally safe. Gonnachon et al. ( 30 ) reported mild subscapularis atrophy in some patients at 6-month follow-up, but without associated strength deficits at 1 year, likely related to implant positioning. In summary, the arthroscopic Trillat technique represents a valuable alternative to procedures like Latarjet in cases of functional instability without significant bone loss. Its minimally invasive nature allows for faster recovery and reduced morbidity. However, optimal results depend on proper patient selection and technical precision. Further high-quality comparative studies and long-term follow-up are necessary to define its definitive role in shoulder stabilization algorithms. The Trillat technique would be indicated in patients with severe instability and subcritical bone loss. It is particularly suited for cases in which the surgeon aims to achieve a tenodesis effect on the subscapularis without altering the anatomy of the subscapularis or other soft tissues. Instead, it acts exclusively on the bony anatomy of the coracoid process. 4.6. Strengths, Limitations, and Future Lines of Research This systematic review brings together the latest evidence on four key arthroscopic techniques used to treat anterior shoulder instability: Arthroscopic Latarjet, Arthroscopic Trillat, Dynamic Anterior Stabilization (DAS), and Shoulder Ligamentoplasty. By comparing these different surgical approaches, the review provides valuable insights to help clinicians make informed decisions based on each patient's specific needs. Another strength is its broad scope, as it considers techniques suitable for various degrees of instability and bone loss. This makes it relevant to a wide range of cases. However, the diversity of patient populations, follow-up times, and evaluation scales used—common in studies of this nature—can be considered limitations. The use of certain methodologies often excludes others that could provide additional, broadly relevant data. It should also be noted that the conclusions of this review are based on articles identified through our search strategy and selected according to specific eligibility criteria. Therefore, there is always a possibility that some studies were not included due to classification issues or limitations in the search process. Looking ahead, future research should prioritize well-designed randomized controlled trials (RCTs) and direct comparative studies (DCS). These are essential for establishing clearer clinical guidelines and identifying the most appropriate surgical techniques for each patient profile. Prospective cohort studies with long-term follow-up are also necessary to better understand the durability and effectiveness of each approach over time. Standardizing outcome measures would enhance comparability across studies. Subgroup analyses could further identify which techniques are best suited for specific patient characteristics. In addition, predictive models based on individual risk factors may help personalize surgical decision-making. Further research should also explore the use of advanced imaging techniques to assess healing and graft integration, as well as conduct cost-effectiveness analyses. Finally, continued innovation in minimally invasive procedures will be key to reducing complications and improving recovery times. 5. Practical Applications From a clinical perspective, this systematic review offers valuable guidance for individualized surgical decision-making in the management of anterior shoulder instability. Arthroscopic Latarjet remains the gold standard for patients with significant glenoid bone loss. In contrast, Dynamic Anterior Stabilization (DAS) and ligamentoplasty represent promising alternatives for cases of subcritical instability. Understanding the specific advantages and limitations of each technique is essential to improving outcomes and minimizing complications. For example, suture-button fixation in the Latarjet procedure appears to reduce graft-related complications. Ligamentoplasty, by preserving native anatomy, is a suitable option for patients with hyperlaxity or those at risk of future instability. For athletes and highly active individuals, arthroscopic Trillat and DAS may offer a faster return to sport due to their minimally invasive nature and better preservation of joint biomechanics. Ligamentoplasty is increasingly recognized for providing stability without permanently altering joint structures. Since it requires only a short period of immobilization and the implanted ligament limits pathological mobility, it enables high-demand patients to return to their previous activity levels more quickly. Postoperative rehabilitation protocols must be tailored to the surgical technique used in order to optimize functional recovery and reduce recurrence rates. Beyond guiding treatment decisions and rehabilitation planning, this review also identifies gaps in current evidence, supports patient-centered communication regarding surgical options, and contributes to the development of future clinical practice guidelines based on high-quality evidence. 6. Conclusions The results of this systematic review of different studies present the evidence for the surgical techniques of shoulder ligamentoplasty, arthroscopic Latarjet, dynamic anterior stabilization (DAS), and arthroscopic Trillat for the treatment of shoulder instability. Arthroscopic ligamentoplasty excels in preserving the patient’s native anatomy. This not only maintains joint integrity but also allows for the possibility of alternative techniques in case of failure. The arthroscopic Trillat technique offers a minimally invasive option for anterior instability without significant bone loss. Although it alters the anatomy, the modification is limited and achieves a tenodesis-like effect on the subscapularis. The DAS technique uses the biceps tendon to provide dynamic stabilization and aims to generate a sling effect over the subscapularis. Finally, the Latarjet procedure remains the gold standard for treating anterior glenoid bone loss greater than 20%. Each surgical technique for anterior shoulder instability has specific implications. The choice of treatment should be based on an individualized assessment that considers bone loss, capsuloligamentous quality, and the patient’s functional demands. Declarations Ethics approval and consent to participate The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of European Atlantic University, Santander, Spain (Approved: January 31, 2025). Consent for publication Not applicable. Availability of data and materials All datasets generated for this study are included in the article/supplementary material. Competing interests The authors declare that they have no competing interests. Funding The APC was funded by Universidad Europea del Atlántico . Authors' contributions C.G.-R.: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing – original draft, writing – review & editing; Y.B.-R.: project administration, resources, software, supervision; F.M.-L..: supervision; Á.V.-S.: Conceptualization, formal analysis, investigation, methodology, supervision, validation, visualization, writing – original draft, writing – review & editing. All authors have read and agreed to the published version of the manuscript. Acknowledgements Not applicable. References Boone JL, Arciero RA. Management of failed instability surgery: how to get it right the next time. Orthop Clin North Am. 2010 Jul;41(3):367–79 Robinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. 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Cite Share Download PDF Status: Published Journal Publication published 11 Nov, 2025 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted Editorial decision: Revision requested 01 Oct, 2025 Reviews received at journal 21 Sep, 2025 Reviewers agreed at journal 16 Sep, 2025 Reviewers agreed at journal 12 Sep, 2025 Reviewers invited by journal 11 Sep, 2025 Editor assigned by journal 11 Sep, 2025 Submission checks completed at journal 11 Sep, 2025 First submitted to journal 08 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":78711,"visible":true,"origin":"","legend":"\u003cp\u003ePICOS Model\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7563726/v1/5189e556e3924775cd7b2fcb.png"},{"id":91839633,"identity":"dbe6b769-e727-4b49-be6a-dc8e386f266e","added_by":"auto","created_at":"2025-09-22 09:52:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46857,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of the study selection.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7563726/v1/f031521a753448df798bbda1.png"},{"id":91839651,"identity":"dce48f44-28b0-4c48-82de-e5f141278bca","added_by":"auto","created_at":"2025-09-22 09:52:49","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":252223,"visible":true,"origin":"","legend":"\u003cp\u003eRisk of bias summary: authors’ judgments about each risk of bias item, presented as percentages across all included studies.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7563726/v1/d3d7a3495a29503471dc308e.png"},{"id":91839634,"identity":"bd9d449e-4bb4-4a55-89b9-66b7ac57577e","added_by":"auto","created_at":"2025-09-22 09:52:48","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":50631,"visible":true,"origin":"","legend":"\u003cp\u003eRisk of bias summary: authors’ judgments about each risk of bias item for each included study.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7563726/v1/84f94160e6730da642ee4037.png"},{"id":91839638,"identity":"e0309272-04be-4d2a-a39c-069ab15ab6b2","added_by":"auto","created_at":"2025-09-22 09:52:49","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":17520,"visible":true,"origin":"","legend":"\u003cp\u003eChronology of the number of studies published on surgical techniques for treating shoulder instability.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7563726/v1/c6f04d90a89bd228bda9d603.png"},{"id":91839639,"identity":"93eecc31-dfab-4090-b850-c93326860738","added_by":"auto","created_at":"2025-09-22 09:52:49","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":211653,"visible":true,"origin":"","legend":"\u003cp\u003eSurgical Techniques\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7563726/v1/b277584af5324cf6ca834d22.png"},{"id":96105918,"identity":"31370ef5-fafd-4727-b647-569d9fa4642a","added_by":"auto","created_at":"2025-11-17 16:12:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2764018,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7563726/v1/60cc9698-b5b9-4af8-a145-2599a49f203a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Shoulder Ligamentoplasty, Arthroscopic Latarjet, Dynamic Anterior Stabilization, and Arthroscopic Trillat for the Treatment of Shoulder Instability: A Systematic Review of Original Studies on Surgical Techniques","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eRecurrent anterior shoulder instability involves repeated glenohumeral dislocations that often require reduction maneuvers. Its estimated incidence is 1.7%, with traumatic etiology accounting for approximately 90% of cases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This condition significantly impairs quality of life, leading to chronic pain, functional limitations, and restrictions in daily activities (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). It is frequently associated with structural osseous and capsuloligamentous abnormalities that compromise joint stability (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eKey osseous defects include Hill-Sachs lesions, characterized by indentation of the humeral head, and anteroinferior glenoid bone loss (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The most common capsuloligamentous injury is a Bankart lesion, involving detachment of the glenoid labrum and glenohumeral ligaments. HAGL lesions may also be present, although they are often underdiagnosed (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). A comprehensive assessment is crucial for selecting appropriate treatment, taking into account factors such as age under 25 years, history of dislocations, ligamentous laxity, muscular function, neurological conditions, and participation in high-demand activities (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe shoulder, often compared to a large sphere resting on a small base, permits extensive motion but has limited intrinsic stability, making it particularly prone to recurrent dislocation following trauma (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Studies indicate that 86% of primary dislocations involve glenoid bone defects, 94% are associated with Hill-Sachs lesions, and 81% present with both (bipolar lesions) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). These injuries commonly coexist with capsulolabral damage of varying degrees, from isolated labral detachments to extensive soft tissue loss (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSurgical treatment has advanced significantly, with arthroscopic Bankart repair now considered the standard of care for patients without significant bone loss and with stable Hill-Sachs lesions (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, ongoing debate surrounds the specific threshold of bone loss that warrants augmentation procedures. There is currently no universally accepted classification system for stratifying soft tissue injuries to guide surgical decision-making (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). A glenoid bone loss greater than 20% is regarded as critical and typically requires bone augmentation or reconstruction. Nonetheless, some studies suggest that bone loss as low as 13.5% may lead to suboptimal outcomes if left untreated (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Similar challenges arise with soft tissue pathology, as both the quantity and quality of tissue influence joint stability and the feasibility of successful repair (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFor minor bone or ligamentous deficits, Bankart repair\u0026mdash;potentially supplemented with remplissage\u0026mdash;is the preferred approach. In contrast, when bone loss exceeds 20%, or in cases of recurrent dislocations or substantial soft tissue insufficiency, bone reconstruction techniques such as the open Latarjet or bone grafting are recommended, despite their higher complication rates (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The main therapeutic dilemma arises in moderate bone loss cases, where the decision between Bankart with remplissage and Latarjet-type procedures remains contentious. Although both techniques demonstrate comparable recurrence rates, Latarjet procedures are associated with a higher complication rate\u0026mdash;up to 30% in some series\u0026mdash;and a reoperation rate of approximately 7% (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDi Giacomo et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) proposed an algorithm for treating anterior instability based on the extent of glenoid bone loss. Bone loss of less than 15% favors soft tissue repair, whereas losses between 17\u0026ndash;25%\u0026mdash;the so-called \"gray zone\"\u0026mdash;require individualized surgical planning. Sedentary individuals or non-contact athletes may benefit from isolated arthroscopic repair. However, contact athletes tend to achieve better outcomes with glenoid reconstruction. Shaha et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) introduced the concept of subcritical bone loss, showing that glenoid bone loss exceeding 13.5% results in poor functional outcomes with Bankart-only repair, even in the absence of recurrent dislocations. This finding suggests that, in active patients, soft tissue repair alone may be insufficient for long-term success.\u003c/p\u003e\u003cp\u003eOver the past two decades, shoulder instability treatment has evolved from open surgery to advanced arthroscopic techniques. The development of arthroscopic Latarjet, Dynamic Anterior Stabilization (DAS), arthroscopic ligamentoplasty, and Trillat procedures has expanded treatment options, improving joint stability, reducing complications, and optimizing recovery (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). These techniques bridge the gap between open surgery\u0026mdash;which offers greater stability but carries a higher risk of complications\u0026mdash;and conventional arthroscopic repairs, which are less invasive but may have higher recurrence rates in subcritical bone loss cases. They offer personalized, hybrid solutions that optimize clinical outcomes while minimizing surgical risks (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAmong these, arthroscopic Latarjet has been validated (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) as a reliable technique, involving the transfer of the coracoid process and conjoint tendon through the subscapularis to the anteroinferior glenoid, thereby restoring bone loss and enhancing dynamic stability via a sling effect. The arthroscopic approach improves graft positioning, facilitates concurrent soft tissue repair, and reduces morbidity and recovery time compared to open procedures. The stabilization mechanism combines a bony block effect that extends the glenoid articular arc, a dynamic sling effect from the subscapularis\u0026ndash;conjoint tendon complex, and capsular reinforcement through attachment to the residual coracoacromial ligament (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAnother validated method is arthroscopic ligamentoplasty (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), where a polyester graft or allograft is anchored sublabral at the anteroinferior glenoid and extended through or over the subscapularis to the proximal humerus, reinforcing anterior capsular stability. Similarly, the arthroscopic Trillat procedure (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) modifies the position of the coracoid to reduce the subcoracoid space, optimizing tension in the conjoint tendon to enhance anterior shoulder stability. Dynamic Anterior Stabilization (DAS) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) involves transferring the biceps tendon to the anterior glenoid, mimicking the sling effect and providing dynamic stabilization via a less invasive technique.\u003c/p\u003e\u003cp\u003eCurrently, no Level 1A studies directly compare these surgical techniques for treating shoulder instability. However, existing evidence suggests that their outcomes are comparable, supporting their role as viable alternatives in managing severe instability.\u003c/p\u003e\u003cp\u003eTherefore, the main aim of this systematic review was to collect, synthesize, and integrate international research published across various scientific databases on shoulder ligamentoplasty, arthroscopic Latarjet, dynamic anterior stabilization, and arthroscopic Trillat techniques for the treatment of shoulder instability. This way, this review determines the current state of the knowledge about this topic and allows a better understanding of the existing problems, making easier the development of future lines of research.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. \u003cb\u003eSearching strategies and sources of information\u003c/b\u003e\u003c/h2\u003e\u003cp\u003eThis article presents a systematic review focused on surgical techniques for the treatment of recurrent anterior shoulder instability. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA\u0026reg;) guidelines (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), ensuring methodological integrity. The review was registered in PROSPERO (ID =). Methodological issues were addressed using the guidance provided by the Cochrane Handbook for Systematic Reviews of Interventions (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe PICOS\u0026reg; model was used to define the inclusion criteria (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e): P (Population): \"patients with recurrent shoulder instability,\" I (Intervention): \"shoulder stabilization surgery,\" C (Comparators): \"comparison groups of multidisciplinary interventions,\" O (Outcome): \"shoulder mobility, dislocation rate, return-to-play (RTP) rate, pain,\" and S (Study design): \"any study design\" (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA structured search was conducted in MEDLINE/PubMed, Web of Science (WOS), ScienceDirect, Cochrane Library, SciELO, EMBASE, SPORTDiscus, and Scopus. The search was completed on January 30, 2025. Search terms included a combination of Medical Subject Headings (MeSH) and free-text keywords related to concepts such as shoulder instability, surgical techniques, and arthroscopic procedures. Specifically, the following search equation was used: [\"\u003cem\u003eshoulder instability\u003c/em\u003e\" (MeSH Terms) OR \"\u003cem\u003eshoulder dislocation\u003c/em\u003e\" (All Fields)] AND [\"\u003cem\u003eLatarjet outcomes\u003c/em\u003e\"] AND [\"\u003cem\u003eDynamic Anterior Stabilization Shoulder\u003c/em\u003e\" (MeSH Terms)] AND [\"\u003cem\u003eTrillat Shoulder\u003c/em\u003e\" (MeSH Terms)] AND [\"\u003cem\u003eShoulder Ligamentoplasty\u003c/em\u003e\" (MeSH Terms)]. This searches equation retrieved all relevant articles in the field. Additionally, the reference sections of the included articles were examined using the \"snowballing method\" (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), which involves reviewing the citations within retrieved studies. All titles and abstracts from the search were screened to identify duplicates and any potentially missing studies (C.G.-R. and A.V.-S). Titles and abstracts were selected for full-text review. The search for published studies was conducted independently by two different authors (C.G.-R. and A.V.-S), and any disagreements were resolved through discussion between them.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Inclusion and Exclusion Criteria\u003c/h2\u003e\u003cp\u003eStudies reporting effectiveness outcomes in terms of diagnostic accuracy or performance related to the surgical management of shoulder instability were selected. The systematic review included original studies on surgical techniques for treating severe shoulder instability. Systematic reviews, meta-analyses, conference abstracts, opinion pieces, and posters were excluded. Only studies with a minimum sample size of 10 participants were included. For effectiveness studies, only those that employed at least one arthroscopic shoulder stabilization technique were considered. The surgical techniques examined for comparison included arthroscopic Latarjet, arthroscopic Trillat, Dynamic Anterior Stabilization, and shoulder ligamentoplasty.\u003c/p\u003e\u003cp\u003eFor the articles retrieved during the search, the following inclusion criteria were applied to the final selection: (I) studies published in peer-reviewed journals with full-text availability; (II) articles analyzing the effects of stabilization surgeries in patients with shoulder instability; (III) original research articles published in peer-reviewed journals with an impact factor; (IV) studies involving patients treated with arthroscopic Latarjet, arthroscopic Trillat, Dynamic Anterior Stabilization, or shoulder ligamentoplasty; (V) study populations consisting of patients who underwent arthroscopic techniques for the treatment of recurrent shoulder instability; (VI) studies that included preoperative and/or postoperative clinical evaluations; (VII) studies published in English and/or Spanish. The following exclusion criteria were applied to experimental research protocols: (I) lack of reliable measurements; (II) studies with fewer than 10 participants; (III) use of open surgical techniques; (IV) fixation methods involving metal buttons or staples; (V) abstracts, non-peer-reviewed articles, and book chapters.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Study Selection\u003c/h2\u003e\u003cp\u003eTitles and abstracts of publications identified through the search strategy were reviewed for full-text selection and cross-checked to eliminate duplicates. All studies assessed for eligibility and classified as relevant were retrieved, and their full texts were peer-reviewed by two authors (C.G.-R. and A.V.-S). Additionally, the reference sections of all relevant articles were examined using the snowballing strategy (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Based on the information provided in the full-text articles, inclusion and exclusion criteria were applied to select eligible studies for inclusion in this systematic review. Any disagreements were resolved through discussion between the two authors (C.G.-R. and A.V.-S).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Data Extraction\u003c/h2\u003e\u003cp\u003eOnce the inclusion and exclusion criteria were applied to each study, the following data were extracted: study source (author(s) and year of publication); sample population, including number of participants; weeks of immobilization; recurrence or dislocation rate; surgical technique used; type of study design; variables analyzed; results and conclusions; and intervention effects.\u003c/p\u003e\u003cp\u003eFor each study, information was carefully collected from all eligible publications. Mean (\u0026plusmn;), standard deviation (SD), and sample size data were extracted from the tables of all included studies. Disagreements were subsequently resolved through discussion until consensus was reached.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5. Quality assessment and Risk of Bias\u003c/h2\u003e\u003cp\u003eMethodological quality and risk of bias were assessed independently by two authors (C.G.-R. and A.V.-S), with any disagreements resolved by a third reviewer (J.C.-G), in accordance with the Cochrane Collaboration Guidelines (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Cochrane Risk of Bias tool included the following domains: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) selection bias (random sequence generation, allocation concealment), (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) performance bias (blinding of participants and personnel), (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) detection bias (blinding of outcome assessment), (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) attrition bias (incomplete outcome data), (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) information bias (selective reporting), and (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) other sources of bias.\u003c/p\u003e\u003cp\u003eFor each investigation, the criteria were shown as \"low\" if the criteria were met for low-risk bias (unlikely to seriously alter the results) or \"high\" if the criteria were for high-risk bias (seriously undermining the reliability of the results). If the risk of bias was unknown, it was considered \"unclear\" (it casts doubt on the results).\u003c/p\u003e\u003cp\u003eThe systematic review followed the principles of the PRISMA\u0026reg; statement (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), a checklist designed to ensure transparency in systematic reviews and to improve their scientific credibility. PRISMA\u0026reg; includes 27 items and a flow chart with four stages, which includes items considered essential for the transparent communication of a systematic analysis.\u003c/p\u003e\u003cp\u003eThe Physiotherapy Evidence Database (PEDro) scale was also used to assess the methodological quality of all selected studies. This scale is a commonly used tool in literature reviews and is designed to evaluate the quality of clinical trial designs (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). It is based on a list developed by Verhagen (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) using the Delphi technique (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\"Physiotherapy Evidence Database (PEDro) scale to analyze the methodological quality of the studies\".\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003ePEDro scale\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe selection criteria were specified\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe subjects were randomly assigned to the groups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe allocations were undisclosed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe groups were similar at baseline in relation to the indicators of prognosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll subjects were blinded\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll the sports scientists providing therapy were blinded\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll assessors evaluating at least one of key results were blinded\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll the measures of at least one of the key results were obtained from more than 85% of the subjects initially assigned to the groups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe results of all the subjects receiving treatment or assigned to the control group were given, or when not possible, the data for at least one key result were analyzed \"in order to treat\"\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe results of statistical comparisons among groups were reported for at least one key result\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe study provides specific and variability measures for at least one key result\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe PEDro scale has a total of 11 items. Item 1 refers to the external validity of the study, while items 2\u0026ndash;9 refer to internal validity. Items 10 and 11 indicate whether the statistical information provided by the authors allows for accurate interpretation of the results. All items on the list are dichotomized as \"yes\", \"no\", or \"not reported\". Each item marked \"yes\" receives one point, while items marked \"no\" or \"not reported\" receive no points.\u003c/p\u003e\u003cp\u003eThe first item of the PEDro scale was not considered in this review, as it relates to the evaluation of external validity. Therefore, only items 2 through 11 were used to assess methodological quality. As a result, the maximum possible score for an article was 10 points, and the minimum possible score was 0.\u003c/p\u003e\u003cp\u003eThe evaluation of heterogeneity was another aspect considered in the review. Clinical heterogeneity refers to differences among types of patients, treatments, and outcomes. Methodological heterogeneity refers to variability in study designs and bias control.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Main Search\u003c/h2\u003e\u003cp\u003eThe database search identified 963 publications. Of the 963 articles retrieved, 16 were excluded given that they were duplicates. A digital screening of sources generated 807 relevant studies, which were included for review. After a detailed review of titles, abstracts, and full texts, 64 publications met the inclusion criteria. Subsequently, 40 articles were excluded for not addressing the surgical techniques under review or for being editorials, surgical technique descriptions, citations, reviews, posters, commentaries, or comparative studies. Studies involving epileptic patients were also excluded.\u003c/p\u003e\u003cp\u003eFrom the final selection, 25 studies were included in the systematic review. Seven articles contained significant data on the arthroscopic Trillat technique [(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)]. Four articles reported significant findings related to the Dynamic Anterior Stabilization technique [(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)]. Three articles presented relevant data on anterior shoulder ligamentoplasty [(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e)]. Eleven articles provided significant information on the arthroscopic Latarjet technique [(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e), (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e), (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e), (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e), (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e), (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e)] (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Study Characteristics\u003c/h2\u003e\u003cp\u003eThe source of each study (author and year of publication), immobilization time, number of episodes of instability including recurrent dislocations and subluxations, surgical technique, type of study design, study variables, main findings, and the effects of the intervention are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. A total of 25 original articles were included with significant data related to the arthroscopic techniques analyzed, specifically Trillat, Dynamic Anterior Stabilization (DAS), arthroscopic Latarjet, and shoulder ligamentoplasty procedures.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMethodology and results of the interventions.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEps.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSurgical technique\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDesign\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMain Findings\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eEffects\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLabattut et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Trillat 1 screw\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRetrospective descriptive (at least 1 year follow-up)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eWalch-Duplay score Rowe score\u003c/p\u003e\u003cp\u003eExternal rotation loss Patient satisfaction\u003c/p\u003e\u003cp\u003ePositive lift-off test\u003c/p\u003e\u003cp\u003eIntra-operative complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSatisfactory short- and mid-term stability, simple procedure, short operative time, no specific complications.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026rarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGonnachon et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eno info\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Trillat\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSingle center, retrospective study.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMorphological parameters were measured on all the rotator cuff muscles: cross sectional area (CSA), thickness and fatty infiltration using the mean muscle attenuation (MMA) measurement. Isokinetic tests were done 1 year post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMinor subscapularis atrophy at 6 months, no strength deficit at 1 year, likely screw-related\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChauvet et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (3.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic\u003c/p\u003e\u003cp\u003eTrillat\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eretrospective\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003cp\u003eRowe\u003c/p\u003e\u003cp\u003eWalch-Duplay\u003c/p\u003e\u003cp\u003esubjective\u003c/p\u003e\u003cp\u003eshouldervalue\u003c/p\u003e\u003cp\u003eshoulder range of motion\u003c/p\u003e\u003cp\u003exRay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eGood outcomes for chronic anterior instability; not recommended for \u0026gt;\u0026thinsp;20% glenoid loss.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKazum et al (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e??\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (o%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Trillat\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eretrospective review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eConstant-Murley Walch-Duplay\u003c/p\u003e\u003cp\u003eROWE\u003c/p\u003e\u003cp\u003eSubjective Shoulder Value (SSV)\u003c/p\u003e\u003cp\u003eVisual Analogue Scale (VAS). Post-operatively, healing of the coracoid osteoclatsy was evaluated by CT scan.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eEffective for recurrent instability and apprehension in anterior/inferior hyperlaxity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoileau et al (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Trillat technique\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eretrospective evaluation of patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ex-rays\u003c/p\u003e\u003cp\u003ecomputed tomography scans\u003c/p\u003e\u003cp\u003eSubjective Shoulder Value\u003c/p\u003e\u003cp\u003evisual analog scale Walch\u003c/p\u003e\u003cp\u003eConstant\u003c/p\u003e\u003cp\u003eRowe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eEffective for young athletes with hyperlaxity and no major bone loss; enables return to sports.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoileau et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Trillat technique\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTwenty-one consecutive patients retrospectively reviewed.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ex-rays\u003c/p\u003e\u003cp\u003ecomputed tomography scan Subjective Shoulder Value\u003c/p\u003e\u003cp\u003evisual analog scale Walch\u003c/p\u003e\u003cp\u003eConstant\u003c/p\u003e\u003cp\u003eRowe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDurable option for recurrent dislocations in older patients with chronic MIRCTs and preserved motion.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMoore et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Trillat technique\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMulticenter retrospective study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDislocation recurrence. Subluxation recurrence\u003c/p\u003e\u003cp\u003eFunctional outcomes\u003c/p\u003e\u003cp\u003eTime and level of return to sport\u003c/p\u003e\u003cp\u003eBony fusion complications. Constant\u003c/p\u003e\u003cp\u003eRowe\u003c/p\u003e\u003cp\u003eWalch Duplay Shoulder Subjective Value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eHighly effective for athletes with chronic instability; enables rapid return to sport.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDe Campos et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (6.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic DAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eunicentric single-arm prospective study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eWestern Ontario Shoulder\u003c/p\u003e\u003cp\u003eInstability Index Rowe score\u003c/p\u003e\u003cp\u003erange of motion strength\u003c/p\u003e\u003cp\u003eability to return to play at same level\u003c/p\u003e\u003cp\u003elack of recurrence of instability\u003c/p\u003e\u003cp\u003esuccessful LHB healing\u003c/p\u003e\u003cp\u003elack of complications.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDAS improves function, ensures LHB healing, and is safe for AGI with 20% GBL.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCollin et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.5 wk (10d)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (13.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic DAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eA retrospective evaluation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRowe score\u003c/p\u003e\u003cp\u003erange of motion (ROM)\u003c/p\u003e\u003cp\u003erecurrence.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDAS supports Bankart repair in subcritical bone loss; preserves ROM, no Popeye deformity.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWu et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (o%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic DAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eretrospective cohort study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003epatient-reported outcomes\u003c/p\u003e\u003cp\u003erange of motion return to sports (RTS)\u003c/p\u003e\u003cp\u003ePostoperative recurrent instability complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDAS-LHB and DAS-CT show similar recurrence, complications, STR, and function\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026rarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDe Campos et al. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic DAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003esingle-arm prospective study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFF\u003c/p\u003e\u003cp\u003eAbd\u003c/p\u003e\u003cp\u003eE R\u003c/p\u003e\u003cp\u003eIR\u003c/p\u003e\u003cp\u003eWOSI\u003c/p\u003e\u003cp\u003eRoweScore Shoulder Abduction Strength (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSignificant improvement in WOSI and Rowe scores (above MCID).\u003c/p\u003e\u003cp\u003eMRI: Successful LHB tendon healing at glenoid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCuellar et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 wk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (5.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic ligamentoplasty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eretrospective descriptive study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eConstant-Murley Score, subjective outcomes, radiographic control, ROM, apprehension signs, relocation tests, and shoulder laxity (anterior, posterior, inferior 'sulcus' tests)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e59.6% excellent outcomes with no pain, full mobility and return to sports; 90% patient satisfaction.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026rarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSanchez et al. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 wk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic ligamentoplasty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eretrospective descriptive study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eConstant score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSafe arthroscopic technique with good results\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eS\u0026aacute;nchez et al.(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 wk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (3.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic ligamentoplasty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003emulticenter retrospective study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eConstant score\u003c/p\u003e\u003cp\u003edegree of subjective satisfaction\u003c/p\u003e\u003cp\u003eStability\u003c/p\u003e\u003cp\u003emobility\u003c/p\u003e\u003cp\u003epain\u003c/p\u003e\u003cp\u003eRTP\u003c/p\u003e\u003cp\u003ereoperation complications.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eGood objective and subjective outcomes. This technique expands stabilizing surgical options\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDescamps et al. (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Latarjet Procedure with Button Fixation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSingle-Center Retrospective Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRadiography (RX) Computed Tomography (CT)\u003c/p\u003e\u003cp\u003eRowe Score\u003c/p\u003e\u003cp\u003eAge\u003c/p\u003e\u003cp\u003eSex\u003c/p\u003e\u003cp\u003eHyperlaxity\u003c/p\u003e\u003cp\u003eISIS Score\u003c/p\u003e\u003cp\u003eSports\u003c/p\u003e\u003cp\u003eBilateral Instability\u003c/p\u003e\u003cp\u003ePrevious Failed Soft Tissue Surgery\u003c/p\u003e\u003cp\u003eSmoking Status\u003c/p\u003e\u003cp\u003eGlenoid Bone Loss, Hill-Sachs Lesion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSafe, durable for recurrent instability; high RTS, minimal OA; suture button lowers complications vs screws.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026rarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDumont et al. (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 wk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eArthroscopic\u003c/b\u003e Latarjet procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eClinical retrospective study.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDislocations, subluxations, reoperations, WOSI score, and 15% complication rate in 64 patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eLow recurrence; better than Bankart, comparable to open Latarjet; reliable but technically demanding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoileau et al. (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Latarjet procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eForty-seven consecutive patients\u003c/p\u003e\u003cp\u003eLevel of Evidence: Level IV, therapeutic case series.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRowe\u003c/p\u003e\u003cp\u003eWalch Duplay\u003c/p\u003e\u003cp\u003erecurrence\u003c/p\u003e\u003cp\u003emobility\u003c/p\u003e\u003cp\u003estability\u003c/p\u003e\u003cp\u003eRTS (return to sport)\u003c/p\u003e\u003cp\u003epain\u003c/p\u003e\u003cp\u003eX-ray\u003c/p\u003e\u003cp\u003eCT scan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eReproducible, safe, with good cosmetic and functional outcomes.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026rarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMouchanta et al. (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Latarjet procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eA multicenter retrospective study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRTS, time to rugby practice, athletic level, patient satisfaction, recurrence, apprehension, SSV (subjective shoulder value), 3-month CT scan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eEffective for rugby players; high RTP, low recurrence, high patient satisfaction.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026rarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeraner et al. (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Latarjet procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eA total of 132 shoulders retrospective study.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eThe aim of this study is to evaluate the clinical outcomes and complications of the procedure, with a particular focus on the infection rate and nerve damage.\u003c/p\u003e\u003cp\u003eThe DASH questionnaire was completed by 60% of the patients.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eReliable for shoulder instability; prevents chronic luxation with low recurrence.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026rarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePelletier et al. (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Cortical-Button Latarjet Procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eThis is a monocentric retrospective study including 40 patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eactive range of motion apprehension test\u003c/p\u003e\u003cp\u003eRowe\u003c/p\u003e\u003cp\u003eWalch-Duplay\u003c/p\u003e\u003cp\u003eSubjective Shoulder Value Net Promoter Score. Radiologically, evolution of the bone graft and degenerative arthritis of the shoulder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e95% RTP, 7.5% recurrence, 16% apprehension, 19% GH osteoarthritis, high satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTadeu et al. (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Latarjet procedure with endobuttons\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMethods: A retrospective study of 26 patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDASH\u003c/p\u003e\u003cp\u003eUCLA\u003c/p\u003e\u003cp\u003eRowe\u003c/p\u003e\u003cp\u003eVisual Analog Scale (VAS) Short-Form 36 (SF36) Correct position and consolidation of the graft were evaluated.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eEffective, safe, good functional outcomes, enables early rehabilitation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026rarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShao et al. (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e425\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e?\u0026iquest;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,50%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Bristow versus Latarjet with screws or buttons\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eA prospective longitudinal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRecurrent dislocation, subluxation, and infections led to reoperations. Complications: 27.1% in Bristow, 25.6% in Latarjet, mainly graft-related (11.7%) and neurological (10.7%).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSuture-button Bristow has fewer complications than screw fixation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026darr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBrzoska et at. (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (8.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Latarjet procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStudy Design: Case series; Level of evidence, 4. 50 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSport activity assessed via KJOC, RTS score, Constant-Murley, Walch-Duplay, ROM, complications, recurrence, and revisions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e95.7% RTS after arthroscopic Latarjet, with occasional complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026rarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShao et al. (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u0026ndash;6 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Latarjet procedure with modified button fixation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRetrospective study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUCLA\u003c/p\u003e\u003cp\u003eASES\u003c/p\u003e\u003cp\u003eRowe\u003c/p\u003e\u003cp\u003eRadiologic assessment\u003c/p\u003e\u003cp\u003eon 3D CT scan was performed preoperatively and postoperatively. Compli\u003c/p\u003e\u003cp\u003ecations were also recorded.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eModified suture-button Latarjet ensures stable fixation, good outcomes, low complications, and bone remodeling.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026darr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZeng et al. (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 wks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eArthroscopic Latarjet procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRetrospective study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eWalch-Duplay, SSV, Rowe, AROM, and 3D CT assessed graft position and bone resorption.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eArthroscopic Latarjet\u0026thinsp;+\u0026thinsp;capsular repair shows good short-term outcomes; long-term effects need further study.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026rarr;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003cb\u003e\u0026uarr;: positive effect; \u0026rarr;: no effect; \u0026darr;: negative effect; N: sample; IMT: immobilization time; EI: episodes of instability, including recurrent dislocations and subluxations. STechnique: surgical technique; SD: study design; V: variables; MR: Main results; EF: effect\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Risk of Bias\u003c/h2\u003e\u003cp\u003eThe methodological quality and the risk of bias were evaluated following the guidelines of the Cochrane Collaboration (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). For each investigation, the criteria were rated as \"low\" if they were met for a low risk of bias (unlikely to severely alter the results), or \"high\" if they indicated a high risk of bias (significantly weakening the reliability of the results). If the risk of bias was unknown, it was considered \"not clear\" (indicating uncertainty about the results). Every included study was assessed for the risk of bias (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The full assessments of study quality are shown in Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.4. Methodological Quality Assessment\u003c/h2\u003e\u003cp\u003eThe methodological quality of the included and analyzed studies ranged from 3 to 9 points, with an average of 6.92 points. The distribution was as follows: 1 study scored 3 points, 4 studies scored 5 points, 2 studies scored 6 points, 7 studies scored 7 points, 10 studies scored 8 points, and 1 study scored 9 points.\u003c/p\u003e\u003cp\u003eDespite some variation in item scores, there was notable consistency in certain criteria that were clearly met across studies. Specifically, item 4 (\"the groups were similar at baseline in relation to the indicators of prognosis\"), item 10 (\"the study provides specific and variability measures for at least one key result\"), and item 11 (\"the results of statistical comparisons among groups were reported for at least one key result\") were consistently fulfilled. Conversely, none of the studies met item 3 (\"the allocations were undisclosed\"). Finally, one study met all quality criteria except for item 3 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults according to PEDro scale (n\u0026thinsp;=\u0026thinsp;25).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"13\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical trial\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLabattut et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGonnachon et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChauvet et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKazum et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoileau et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoileau et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMoore et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDe Campos et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCollin et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWu et al (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDe Campos et al. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCuellar et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSanchez et al. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSanchez et al. (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDescamps et al. (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGuillaume et al. (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoileau et al. (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMouchant et al. (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeraner et al. (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePelletier et al. (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNascimento et al. (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShao et al. (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBrzoska et al. (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShao et al. (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZeng et al. (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"13\" nameend=\"c13\" namest=\"c1\"\u003e\u003cp\u003eYes: it presents the studied criterium. No: it does not present the studied criterium.\u003c/p\u003e\u003cp\u003e1. The criteria of election were specified; 2. The subjects were randomly assigned to the groups; 3. The assignment was hidden; 4. The groups were similar at the beginning in relation to the most important indicators of prognosis; 5. All participants were blinded; 6. All the sports scientists providing therapy were blinded; 7. All assessors evaluating at least one of key results were blinded; 8. All the measures of at least one of the key results were obtained from more than 85% of the participants initially assigned to the groups; 9. The results of all the subjects receiving treatment or assigned to the control group were given, or when not possible, the data for at least one key result were analysed \u0026ldquo;in order to treat\u0026rdquo;; 10. The results of statistic comparisons among groups were reported for at least one key result; 11. The study provides specific and variability measures for at least one key result.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWith regard to the chronology of the 25 articles studied (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), 13 have been published in the last 17 years; 6 in 2024 (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e); 4 in 2023 (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e); 5 in 2022 (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e); and 2 in 2021 (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). The remaining research corresponds to 8 studies, which are divided into 1 in 2019 (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e); 2 in 2018 (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e); 1 in 2014 (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e); and finally, 4 prior to 2010 (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). The above shows the great interest and importance of use of surgical techniques for the treatment of shoulder instability.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe reviewed studies highlight the clinical utility of these arthroscopic techniques, each offering specific benefits based on patient anatomy and functional needs. The overall evidence supports the effectiveness and safety of these ones. Each technique offers distinct advantages based on anatomical deficits and functional demands, emphasizing the need for personalized surgical planning in the management of anterior shoulder instability.\u003c/p\u003e\u003cp\u003eAll the above information is summarized in the following Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e:\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of surgical techniques for treating shoulder instability\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN\u0026ordm; Studies\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThematic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConclusion\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDynamic Anterior Stabilization (DAS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThis technique would be indicated mainly in patients with recurrent shoulder instability and bone defects of less than 10%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eArthroscopic Latarjet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe technique is especially relevant when unipolar bone loss exceeds 20% of the glenoid surface, notably when associated with humeral bone loss in the form of an off-track Hill-Sachs lesion.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eArthroscopic Ligamentoplasty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIts primary indication would be in patients with high functional demand and multi-recurrent instability, particularly in those with poor or suboptimal capsuloligamentous tissue quality.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eArthroscopic Trillat\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIt is particularly suited for cases in which the surgeon aims to achieve a tenodesis effect on the subscapularis without altering the anatomy of the subscapularis or other soft tissues.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e4.1. Summary of Main Findings\u003c/h2\u003e\u003cp\u003eThe main aim of this of this systematic review was to collect, synthesize, and integrate international research published across various scientific databases on surgical techniques such as shoulder ligamentoplasty, arthroscopic Latarjet, dynamic anterior stabilization, and arthroscopic Trillat for the treatment of shoulder instability.\u003c/p\u003e\u003cp\u003eAnterior shoulder instability is a common condition affecting both the general population and athletes, and represents one of the most frequent causes of functional limitation in the upper limb. Its pathophysiology is based on an imbalance between the dynamic and static stabilizers of the glenohumeral joint, predisposing individuals to recurrent episodes of dislocation and subluxation. This condition, in addition to causing pain and disability, increases the risk of progressive joint deterioration and the development of glenohumeral arthropathy, reinforcing the need for effective and personalized therapeutic intervention (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe surgical treatment of anterior instability has evolved significantly over recent decades, transitioning from highly invasive open procedures to advanced arthroscopic techniques aimed at maximizing joint stability while minimizing tissue damage (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). Among the most widely used and studied techniques are Dynamic Anterior Stabilization (DAS), arthroscopic Latarjet, arthroscopic ligamentoplasty, and arthroscopic Trillat. These techniques have proven effective in different patient subgroups depending on the specific characteristics of their instability, the presence of bone deficits, and the quality of the capsuloligamentous tissue (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese four techniques share the ability to achieve satisfactory outcomes in patients whose instability is influenced by both osseous and soft tissue risk factors. However, a key difference lies in the fact that ligamentoplasty is the only technique that does not alter the patient\u0026rsquo;s anatomy. It involves the repair of all possible structures, the potential execution of a remplissage to address humeral bone defects, and the addition of a ligamentous graft that does not modify the anatomy but acts as an adjunct to the patient\u0026rsquo;s natural structures. This also prevents glenohumeral dislocation in cases where abduction and external rotation are extreme enough for the humeral head to dislocate anteroinferiorly on the scapular glenoid (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis anatomical preservation is not present in DAS, Trillat, or arthroscopic Latarjet, establishing a significant distinction among these techniques. In the latter three, the anatomy is altered to enhance stabilization, and although the objective is effectively achieved, this factor is not without risks or potential future complications (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). These must be carefully considered when determining the best surgical approach for each patient, particularly given that the target population is composed of young and active individuals.\u003c/p\u003e\u003cp\u003eThe indicated measures were verified in terms of efficiency in the different studies analyzed in this review. There currently exist many literary proposals which attempt to consolidate these techniques in terms of prevention protocols, studying their effects in a complex manner. In spite of this, it was observed that preventive actions are not currently implemented systematically.\u003c/p\u003e\u003cp\u003eTherefore, the current scientific literature describes different surgical approaches that aim to balance anatomical preservation, joint stability, and functional recovery (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). However, there is a clear need for more robust comparative data, particularly through randomized controlled trials, to guide optimal technique selection. This systematic review seeks to address this gap by providing a comprehensive analysis of the available evidence, helping clinicians better understand the indications, outcomes, and limitations of each arthroscopic technique used in the management of anterior shoulder instability.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e4.2. Dynamic Anterior Stabilization (DAS)\u003c/h2\u003e\u003cp\u003eThe DAS technique has recently emerged as a less invasive alternative for shoulder stabilization in patients with anterior instability and subcritical bone loss. Its biomechanical principle involves transferring the long head of the biceps tendon through the subscapularis to create a sling effect that enhances joint stability under anterior stress. Unlike other techniques focused on osseous or capsular reconstruction, DAS utilizes the biceps' dynamic stabilizing function to provide active control of humeral translation (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRecent studies (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) have shown promising results with this technique. Clara de Campos Azevedo et al. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) reported a significant reduction in recurrence rates and considerable improvement in postoperative functional scores in patients with subcritical instability treated with DAS. Similarly, Collin et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) found that this technique preserves the range of motion without compromising shoulder function, offering a key advantage over more invasive procedures. Wu et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) observed comparable return-to-sport rates between DAS and other traditional techniques, highlighting its effectiveness in postoperative rehabilitation.\u003c/p\u003e\u003cp\u003eHowever, DAS still presents certain challenges and limitations. Its indication is restricted to patients with mild to moderate bone loss, as its stabilizing effect may be insufficient in cases of critical bone loss. Additionally, the long-term clinical outcomes remain uncertain and under evaluation, requiring further data collection to determine its efficacy compared to more established techniques (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis technique would be indicated mainly in patients with recurrent shoulder instability and bone defects of less than 10%, particularly when associated with pathology of the bicep\u0026rsquo;s tendon or its superior glenoid insertion, and when the goal is to address both conditions while adding a tenodesis effect or sling effect to the subscapularis tendon.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e4.3. Arthroscopic Latarjet\u003c/h2\u003e\u003cp\u003eArthroscopic Latarjet is one of the most widely used techniques for treating anterior instability with critical bone loss. It involves the transfer of the coracoid process along with the conjoint tendon to the anteroinferior region of the glenoid, providing a dual stabilizing effect: the bone block increases contact surface area and prevents excessive humeral translation, while the tension generated by the conjoint tendon acts as a dynamic stabilizing mechanism (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRecent studies (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) have confirmed the effectiveness of arthroscopic Latarjet in preventing recurrence. Descamps et al. (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) reported that suture fixation instead of screws significantly reduced postoperative complications related to graft migration, osteolysis, and consolidation defects, improving procedural safety. Dumont et al. (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) demonstrated that the recurrence rate following surgery is low and comparable to that of open Latarjet, with the additional advantage of reduced surgical aggression and shorter recovery time. Boileau et al. (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) highlighted that this procedure is not only safe and reproducible but also offers superior aesthetic and functional outcomes compared to open techniques.\u003c/p\u003e\u003cp\u003eDespite these benefits, arthroscopic Latarjet remains technically demanding. It requires a high level of surgical expertise. Additionally, patient selection must be meticulous, as graft resorption, hardware-related complications, and glenohumeral arthropathy may present long-term challenges (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis technique, although effective, is not without complications. These may include potential neurological sequelae, especially in patients undergoing revision surgery or presenting with recurrent instability following prior treatments. It is particularly indicated in cases of severe, recurrent instability with extensive capsular and labral damage. The technique is especially relevant when unipolar bone loss exceeds 20% of the glenoid surface, notably when associated with humeral bone loss in the form of an off-track Hill-Sachs lesion. It is a technique that alters the native anatomy and, although highly effective, offers few clear alternative options in the event of failure. This is particularly critical when the joint is already compromised by both the initial instability and the consequences of the procedure or its failure. Therefore, except in selected cases, it should be considered a second-line treatment option.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4.4. Arthroscopic Ligamentoplasty\u003c/h2\u003e\u003cp\u003eArthroscopic ligamentoplasty represents an intermediate surgical option between conventional capsulolabral repair and bone reconstruction techniques in the management of anterior shoulder instability. This technique aims to enhance capsular stabilization through the fixation of a synthetic or biological ligament graft. It increases resistance to humeral head translation while preserving joint mobility. It is the only one of the four techniques that does not alter the patient\u0026rsquo;s native anatomy. The procedure maintains bony integrity, reconstructs the capsuloligamentous structures, and adds mechanical support through the graft itself (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eClinical studies (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e) have demonstrated the potential benefits of arthroscopic ligamentoplasty. Cu\u0026eacute;llar Guti\u0026eacute;rrez et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) reported favorable clinical outcomes in patients with recurrent anterior instability without significant bone loss, achieving a 90% satisfaction rate. These findings were supported by S\u0026aacute;nchez et al., who described effective functional recovery and minimal postoperative morbidity in patients treated with synthetic anterior capsular reinforcement (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Collectively, these results suggest that arthroscopic ligamentoplasty may be a safe and effective surgical option in selected patients. It expands the range of techniques available for shoulder stabilization.\u003c/p\u003e\u003cp\u003eHowever, the role of arthroscopic ligamentoplasty remains a subject of ongoing discussion within the orthopedic community. One of the primary concerns is the variability in graft integration, which may influence the long-term success and mechanical reliability of the procedure. While short- and mid-term results appear promising, further studies are warranted to assess long-term durability, outcomes, and complications, particularly regarding graft behavior over time (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eArthroscopic ligamentoplasty offers a distinct approach to shoulder stabilization by reinforcing the capsular structures without altering the native anatomy. Clinical data support its ability to achieve satisfactory functional recovery and high patient satisfaction in properly selected cases (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Nevertheless, the long-term performance of the technique and the biological behavior of the graft require continued investigation to more clearly define its role in the surgical management of shoulder instability.\u003c/p\u003e\u003cp\u003eThis technique should be more widely adopted. Its primary indication would be in patients with high functional demand and multi-recurrent instability, particularly in those with poor or suboptimal capsuloligamentous tissue quality. It is also indicated in cases of subcritical glenoid bone loss of less than 20%. This technique enables soft tissue repair where feasible and adds both a tenodesis and sling effect to the subscapularis without altering the patient's native anatomy, as the ligament can be placed either through the subscapularis tendon or above its superior border. The implants used have minimal impact on bone stock. The procedure reinforces the anterior capsule and ligaments by introducing a controlled block to extreme external rotation and abduction. All of this is achieved through a fully arthroscopic approach. Alternatively, it may be performed with a minimal axillary incision when the mini-invasive humeral fixation technique is chosen. Moreover, if the surgeon prefers to avoid the use of synthetic grafts due to concerns regarding their healing potential, the technique allows for the use of either an allograft or a tendon autograft. Therefore, it represents our treatment of choice in cases of severe instability in active patients with subcritical bone loss and compromised soft tissue quality.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e4.5. Arthroscopic Trillat\u003c/h2\u003e\u003cp\u003eThe arthroscopic Trillat technique is a minimally invasive and promising surgical option for the treatment of anterior shoulder instability in selected patients without significant bone loss. This procedure involves an arthroscopic coracoid osteotomy to reposition the coracoid process, thereby reducing the subcoracoid space and increasing tension on the conjoint tendon. This biomechanical modification helps limit humeral head translation and enhances joint stability (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eClinical studies (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) have reported positive outcomes, particularly in patients with hyperlaxity or chronic post-traumatic anterior instability. Labattut et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) demonstrated satisfactory short- and mid-term outcomes with a low complication profile, minimal surgical time, and early return to activity. Chauvet et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) confirmed these results with a two-year follow-up, showing sustained shoulder stability and functional recovery. Boileau et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) further highlighted the effectiveness of the technique in two distinct populations: young athletes with hyperlaxity and older patients with recurrent dislocations and massive irreparable rotator cuff tears (MIRCTs) (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe main indications for this technique include recurrent anterior instability in the absence of significant glenoid or humeral bone defects, especially in patients with hyperlaxity. Arthroscopy provides superior visualization of the glenohumeral joint, allowing accurate coracoid osteotomy and secure fixation. The outcomes are encouraging, with improved shoulder stability and low recurrence rates. Kazum et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) found the procedure effective for anterior/inferior hyperlaxity, with minimal postoperative complications. Moore et al. (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e) also reported high functional scores and rapid return to sports in a multicenter study involving athletic populations.\u003c/p\u003e\u003cp\u003eRegarding complications, the technique is generally safe. Gonnachon et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) reported mild subscapularis atrophy in some patients at 6-month follow-up, but without associated strength deficits at 1 year, likely related to implant positioning.\u003c/p\u003e\u003cp\u003eIn summary, the arthroscopic Trillat technique represents a valuable alternative to procedures like Latarjet in cases of functional instability without significant bone loss. Its minimally invasive nature allows for faster recovery and reduced morbidity. However, optimal results depend on proper patient selection and technical precision. Further high-quality comparative studies and long-term follow-up are necessary to define its definitive role in shoulder stabilization algorithms.\u003c/p\u003e\u003cp\u003eThe Trillat technique would be indicated in patients with severe instability and subcritical bone loss. It is particularly suited for cases in which the surgeon aims to achieve a tenodesis effect on the subscapularis without altering the anatomy of the subscapularis or other soft tissues. Instead, it acts exclusively on the bony anatomy of the coracoid process.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e4.6. Strengths, Limitations, and Future Lines of Research\u003c/h2\u003e\u003cp\u003eThis systematic review brings together the latest evidence on four key arthroscopic techniques used to treat anterior shoulder instability: Arthroscopic Latarjet, Arthroscopic Trillat, Dynamic Anterior Stabilization (DAS), and Shoulder Ligamentoplasty. By comparing these different surgical approaches, the review provides valuable insights to help clinicians make informed decisions based on each patient's specific needs. Another strength is its broad scope, as it considers techniques suitable for various degrees of instability and bone loss. This makes it relevant to a wide range of cases.\u003c/p\u003e\u003cp\u003eHowever, the diversity of patient populations, follow-up times, and evaluation scales used\u0026mdash;common in studies of this nature\u0026mdash;can be considered limitations. The use of certain methodologies often excludes others that could provide additional, broadly relevant data.\u003c/p\u003e\u003cp\u003eIt should also be noted that the conclusions of this review are based on articles identified through our search strategy and selected according to specific eligibility criteria. Therefore, there is always a possibility that some studies were not included due to classification issues or limitations in the search process.\u003c/p\u003e\u003cp\u003eLooking ahead, future research should prioritize well-designed randomized controlled trials (RCTs) and direct comparative studies (DCS). These are essential for establishing clearer clinical guidelines and identifying the most appropriate surgical techniques for each patient profile. Prospective cohort studies with long-term follow-up are also necessary to better understand the durability and effectiveness of each approach over time. Standardizing outcome measures would enhance comparability across studies. Subgroup analyses could further identify which techniques are best suited for specific patient characteristics. In addition, predictive models based on individual risk factors may help personalize surgical decision-making. Further research should also explore the use of advanced imaging techniques to assess healing and graft integration, as well as conduct cost-effectiveness analyses. Finally, continued innovation in minimally invasive procedures will be key to reducing complications and improving recovery times.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Practical Applications","content":"\u003cp\u003eFrom a clinical perspective, this systematic review offers valuable guidance for individualized surgical decision-making in the management of anterior shoulder instability. Arthroscopic Latarjet remains the gold standard for patients with significant glenoid bone loss. In contrast, Dynamic Anterior Stabilization (DAS) and ligamentoplasty represent promising alternatives for cases of subcritical instability. Understanding the specific advantages and limitations of each technique is essential to improving outcomes and minimizing complications. For example, suture-button fixation in the Latarjet procedure appears to reduce graft-related complications. Ligamentoplasty, by preserving native anatomy, is a suitable option for patients with hyperlaxity or those at risk of future instability.\u003c/p\u003e\u003cp\u003eFor athletes and highly active individuals, arthroscopic Trillat and DAS may offer a faster return to sport due to their minimally invasive nature and better preservation of joint biomechanics. Ligamentoplasty is increasingly recognized for providing stability without permanently altering joint structures. Since it requires only a short period of immobilization and the implanted ligament limits pathological mobility, it enables high-demand patients to return to their previous activity levels more quickly.\u003c/p\u003e\u003cp\u003ePostoperative rehabilitation protocols must be tailored to the surgical technique used in order to optimize functional recovery and reduce recurrence rates. Beyond guiding treatment decisions and rehabilitation planning, this review also identifies gaps in current evidence, supports patient-centered communication regarding surgical options, and contributes to the development of future clinical practice guidelines based on high-quality evidence.\u003c/p\u003e"},{"header":"6. Conclusions","content":"\u003cp\u003eThe results of this systematic review of different studies present the evidence for the surgical techniques of shoulder ligamentoplasty, arthroscopic Latarjet, dynamic anterior stabilization (DAS), and arthroscopic Trillat for the treatment of shoulder instability. Arthroscopic ligamentoplasty excels in preserving the patient\u0026rsquo;s native anatomy. This not only maintains joint integrity but also allows for the possibility of alternative techniques in case of failure. The arthroscopic Trillat technique offers a minimally invasive option for anterior instability without significant bone loss. Although it alters the anatomy, the modification is limited and achieves a tenodesis-like effect on the subscapularis. The DAS technique uses the biceps tendon to provide dynamic stabilization and aims to generate a sling effect over the subscapularis. Finally, the Latarjet procedure remains the gold standard for treating anterior glenoid bone loss greater than 20%. Each surgical technique for anterior shoulder instability has specific implications. The choice of treatment should be based on an individualized assessment that considers bone loss, capsuloligamentous quality, and the patient\u0026rsquo;s functional demands.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of European Atlantic University, Santander, Spain (Approved: January 31, 2025).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll datasets generated for this study are included in the article/supplementary material.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe APC was funded by Universidad Europea del Atlántico\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eC.G.-R.: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing – original draft, writing – review \u0026amp; editing; Y.B.-R.: project administration, resources, software, supervision; F.M.-L..: supervision; Á.V.-S.: Conceptualization, formal analysis, investigation, methodology, supervision, validation, visualization, writing – original draft, writing – review \u0026amp; editing. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBoone JL, Arciero RA. Management of failed instability surgery: how to get it right the next time. Orthop Clin North Am. 2010 Jul;41(3):367\u0026ndash;79\u003c/li\u003e\n\u003cli\u003eRobinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am. 2006 Nov;88(11):2326\u0026ndash;36\u003c/li\u003e\n\u003cli\u003eMeller R, Krettek C, G\u0026ouml;sling T, W\u0026auml;hling K, Jagodzinski M, Zeichen J. Recurrent shoulder instability among athletes: changes in quality of life, sports activity, and muscle function following open repair. 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J Shoulder Elbow Surg. 2022;31(3):e270\u0026ndash;8. doi:10.1016/j.jse.2021.12.007.\u003c/li\u003e\n\u003cli\u003eKazum E, Martinez-Catalan N, Oussama R, Eichinger JK, Werthel JD, Valenti P. Arthroscopic Trillat procedure combined with capsuloplasty: an effective treatment modality for shoulder instability associated with hyperlaxity. Knee Surg Sports Traumatol Arthrosc. 2022 Jun;30(6):2067\u0026ndash;73. doi:10.1007/s00167-021-06752-z.\u003c/li\u003e\n\u003cli\u003eBoileau P, Clowez G, Bouacida S, Walch G, Schwartz DG, Trojani C. The arthroscopic Trillat procedure is a valuable and durable treatment option for recurrent anterior instability associated with massive irreparable cuff tears. Arthroscopy. 2023 Apr;39(4):935\u0026ndash;45. doi:10.1016/j.arthro.2022.10.045.\u003c/li\u003e\n\u003cli\u003eBoileau P, Clowez G, Bouacida S, Walch G, Trojani C, Schwartz DG. The arthroscopic Trillat procedure is a valuable treatment option for recurrent anterior instability in young athletes with shoulder hyperlaxity. Arthroscopy. 2023 Apr;39(4):948\u0026ndash;58. doi:10.1016/j.arthro.2022.10.046.\u003c/li\u003e\n\u003cli\u003eMoore F, Labattut L, Chauvet T, Bordet A, Martz P. Arthroscopic Trillat technique for chronic anterior shoulder instability: outcomes at 2-year follow-up in 74 at-risk sports patients. J Shoulder Elbow Surg. 2025 May;34(5):1225-1235. doi:10.1016/j.jse.2024.08.029.\u003c/li\u003e\n\u003cli\u003ede Campos Azevedo C, \u0026Acirc;ngelo AC. Onlay dynamic anterior stabilization with biceps transfer for the treatment of anterior glenohumeral instability produces good clinical outcomes and successful healing at a minimum 1 year of follow-up. Arthrosc Sports Med Rehabil. 2023 Apr;5(2):e445\u0026ndash;57. doi:10.1016/j.asmr.2023.01.012.\u003c/li\u003e\n\u003cli\u003eCollin P, Nabergoj M, Denard PJ, Wang S, Bothorel H, L\u0026auml;dermann A. Arthroscopic biceps transfer to the glenoid with Bankart repair grants satisfactory 2-year results for recurrent anteroinferior glenohumeral instability in subcritical bone loss. Arthroscopy. 2022 Jun;38(6):1766\u0026ndash;71. doi:10.1016/j.arthro.2021.11.043.\u003c/li\u003e\n\u003cli\u003eWu C, Xu J, Fang Z, Chen J, Ye Z, Wang L, et al. Arthroscopic dynamic anterior stabilization using either long head of the biceps or conjoined tendon transfer for anterior shoulder instability results in a similarly low recurrence rate. Arthroscopy. 2023 Jul;39(7):1618\u0026ndash;27. doi:10.1016/j.arthro.2022.12.040.\u003c/li\u003e\n\u003cli\u003ede Campos Azevedo C, \u0026Acirc;ngelo AC. All-suture anchor dynamic anterior stabilization produced successful healing of the biceps tendon: a report of 3 cases. JBJS Case Connect. 2021 Feb 17;11(1):e20.00149. doi:10.2106/JBJS.CC.20.00149.\u003c/li\u003e\n\u003cli\u003eCu\u0026eacute;llar Guti\u0026eacute;rrez R, Garc\u0026iacute;a Guti\u0026eacute;rrez A, Sili\u0026oacute; Ochandiano F, Albillos Bartolom\u0026eacute; FJ, Usabiaga Zarranz J. Refuerzo capsular anterior de dacr\u0026oacute;n en el tratamiento de la luxaci\u0026oacute;n recidivante de hombro tipo atraum\u0026aacute;tico. Rev Esp Cir Ortop Traumatol. 1998;43(3):196\u0026ndash;204.\u003c/li\u003e\n\u003cli\u003eS\u0026aacute;nchez M, Cu\u0026eacute;llar R, Garcia A, Albillos J, Azofra J. Anterior Stabilization of the Shoulder by Means of an Artificial Capsular Reinforcement and Arthroscopy\u0026mdash; Part II:\u003csup\u003e 1 \u003c/sup\u003eClinical Results. J Long Term Eff Med Implants. 2000;10(3).\u003c/li\u003e\n\u003cli\u003eDescamps J, Greco V, Chelli M, Boileau P. The arthroscopically guided Bristow-Latarjet procedure with cortical button fixation: a minimum 10-year follow-up. Am J Sports Med. 2024 Nov;52(11):2815\u0026ndash;25. doi:10.1177/03635465241263590.\u003c/li\u003e\n\u003cli\u003eDumont GD, Fogerty S, Rosso C, Lafosse L. The arthroscopic Latarjet procedure for anterior shoulder instability: 5-year minimum follow-up. Am J Sports Med. 2014 Oct;42(10):2560\u0026ndash;6. doi:10.1177/0363546514544682.\u003c/li\u003e\n\u003cli\u003eBoileau P, Mercier N, Roussanne Y, Th\u0026eacute;lu CE, Old J. Arthroscopic Bankart-Bristow-Latarjet procedure: the development and early results of a safe and reproducible technique. Arthroscopy. 2010 Nov;26(11):1434\u0026ndash;50. doi:10.1016/j.arthro.2010.07.011.\u003c/li\u003e\n\u003cli\u003eMouchantaf M, Bastard C, Corsia S, M\u0026eacute;tais P, Nourissat G. High rates of return to play and low recurrence rate after arthroscopic Latarjet procedure for anterior shoulder instability in rugby players. Arthrosc Sports Med Rehabil. 2024 Apr;6(2):100912. doi:10.1016/j.asmr.2024.100912.\u003c/li\u003e\n\u003cli\u003eMeraner D, Smolen D, Sternberg C, Thallinger C, Hahne J, Leuzinger J. 10 years of arthroscopic Latarjet procedure: outcome and complications. Indian J Orthop. 2019 Jan-Feb;53(1):102\u0026ndash;10. doi:10.4103/ortho.IJOrtho_273_17.\u003c/li\u003e\n\u003cli\u003ePelletier J, Barret H, Dalmas Y, Hamzaoui H, Mansat P, Bonnevialle N. Outcomes of arthroscopic cortical-button Latarjet procedure with minimum 5-year follow-up. J Shoulder Elbow Surg. 2024;33(\u0026ndash;):1\u0026ndash;9. doi:10.1016/j.jse.2024.08.041.\u003c/li\u003e\n\u003cli\u003eNascimento AT, Claudio GK, Rocha PB, Zum\u0026aacute;rraga JP, Camargo OP. Arthroscopic Latarjet technique combined with endobuttons: functional outcomes in 26 cases. Acta Ortop Bras. 2018;26(5):328\u0026ndash;31. doi:10.1590/1413-785220182605208650.\u003c/li\u003e\n\u003cli\u003eShao Z, Zhao Y, Luo H, Jiang Y, Song Q, Cheng X, et al. Clinical and radiologic outcomes of all-arthroscopic Latarjet procedure with modified suture button fixation: excellent bone healing with a low complication rate. Arthroscopy. 2022 Jul;38(7):2157\u0026ndash;65. doi:10.1016/j.arthro.2022.01.020.\u003c/li\u003e\n\u003cli\u003eBrzoska R, Laprus H, Malik SS, Solecki W, Juszczak B, Blasiak A. Return to preinjury-level sports after arthroscopic Latarjet for recurrent anterior shoulder instability in professional athletes. Orthop J Sports Med. 2023 May;11(5):23259671231166371. doi:10.1177/23259671231166371.\u003c/li\u003e\n\u003cli\u003eShao Z, Jiang Y, Song Q, Wang H, Luo H, Cheng X, et al. Short-term complications of arthroscopic Bristow or Latarjet procedure with screw versus suture-button fixation: a prospective study of 308 consecutive cases by a single surgeon. J Bone Joint Surg Am. 2024 Oct 2;106(19):1776\u0026ndash;84. doi:10.2106/JBJS.23.00390.\u003c/li\u003e\n\u003cli\u003eZeng Z, Liu C, Liu Y, Huang Y. Early outcomes of the arthroscopic Latarjet procedure in a series of 37 patients with shoulder instability. BMC Musculoskelet Disord. 2021;22:845. doi:10.1186/s12891-021-04726-3.\u003c/li\u003e\n\u003cli\u003eHovelius L, Saeboe M. Neer Award 2008: Arthropathy after primary anterior shoulder dislocation\u0026mdash;223 shoulders prospectively followed up for twenty-five years. J Shoulder Elbow Surg. 2009;18(3):339-347. doi:10.1016/j.jse.2008.10.007.\u003c/li\u003e\n\u003cli\u003eHohmann E, Tetsworth K, Glatt V. Open versus arthroscopic surgical treatment for anterior shoulder dislocation: a comparative systematic review and meta-analysis over the past 20 years. J Shoulder Elbow Surg. 2017;26(10):1873\u0026ndash;1880. doi:10.1016/j.jse.2017.04.009.1\u003c/li\u003e\n\u003cli\u003eG\u0026oacute;mez Cimiano FJ. Ligamentoplastia de hombro, 25 a\u0026ntilde;os de una joven t\u0026eacute;cnica. Rev Esp Artrosc Cir Articul. 2018;25(Supl.1):59-66. doi:10.24129/j.reaca.25e62.fs1802010\u003c/li\u003e\n\u003cli\u003eAchalandabaso J, Golan\u0026oacute; P, Escobar E, Uribarri J, Fari\u0026ntilde;as O. Tratamiento quir\u0026uacute;rgico de la inestabilidad anterior de hombro mediante refuerzo capsular con tendones de la pata de ganso. Cuad Artrosc. 2001 Oct;8(2):10-8.\u003c/li\u003e\n\u003cli\u003eBatty LM, Norsworthy CJ, Lash NJ, Wasiak J, Richmond AK, Feller JA. Synthetic devices for reconstructive surgery of the cruciate ligaments: a systematic review. Arthroscopy. 2015 May;31(5):957-68. doi:10.1016/j.arthro.2014.11.022.\u003c/li\u003e\n\u003cli\u003eMoore F, et al. Arthroscopic Trillat technique: multicenter retrospective study. J Shoulder Elbow Surg. 2024 [In press].\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Ligamentoplasty, Arthroscopic Latarjet, Dynamic Anterior Stabilization, Trillat procedure, Sports injuries, Shoulder instability","lastPublishedDoi":"10.21203/rs.3.rs-7563726/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7563726/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Anterior shoulder instability is a common condition, especially among young and active individuals, often associated with both osseous and soft tissue injuries. Recent innovations have introduced various surgical options for managing critical and subcritical instability. Therefore, he primary objective of this systematic review was to collect, synthesize, and integrate international research published across multiple scientific databases on shoulder ligamentoplasty, arthroscopic Latarjet, dynamic anterior stabilization, and arthroscopic Trillat techniques used in the treatment of shoulder instability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eA structured search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PICOS model, up to January 30, 2025, in the MEDLINE/PubMed, Web of Science (WOS), ScienceDirect, Cochrane Library, SciELO, EMBASE, SPORTDiscus, and Scopus databases. The risk of bias was evaluated, and the PEDro scale was used to assess methodological quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The initial search yielded a total of 964 articles. After applying the inclusion and exclusion criteria, the final sample consisted of 25 articles. These studies demonstrated a high standard of methodological quality. The review summarized the effects of ligamentoplasty, arthroscopic Latarjet, dynamic anterior stabilization, and arthroscopic Trillat techniques in treating shoulder instability, detailing the sample population, immobilization period, frequency of instability episodes—including recurrent dislocations and subluxations—surgical methods, studydesigns, assessed variables,main findings, and reported outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Arthroscopic ligamentoplasty is advantageous in preserving the patient’s native anatomy, maintaining joint integrity, and allowing for alternative interventions in case of failure. The arthroscopic Trillat technique offers a minimally invasive solution for anterior instability without significant bone loss. The DAS technique utilizes the biceps tendon to provide dynamic stabilization, aiming to generate a sling effect over the subscapularis muscle. The Latarjet procedure remains the gold standard for managing anterior glenoid bone loss greater than 20%. Each surgical option for anterior shoulder instability carries specific implications, and treatment decisions should be tailored based on bone loss severity, capsuloligamentous quality, and the patient’s functional needs.\u003c/p\u003e","manuscriptTitle":"Shoulder Ligamentoplasty, Arthroscopic Latarjet, Dynamic Anterior Stabilization, and Arthroscopic Trillat for the Treatment of Shoulder Instability: A Systematic Review of Original Studies on Surgical Techniques","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 09:52:44","doi":"10.21203/rs.3.rs-7563726/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-01T04:49:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-21T17:33:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260245188119090786577657478366633510507","date":"2025-09-16T13:28:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107153678587776134357588994118763218485","date":"2025-09-12T04:37:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-11T12:52:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-11T12:35:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-11T04:00:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2025-09-08T11:28:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"436e9524-ba54-499e-8251-9f3c42d1fe18","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T16:10:26+00:00","versionOfRecord":{"articleIdentity":"rs-7563726","link":"https://doi.org/10.1186/s13018-025-06422-7","journal":{"identity":"journal-of-orthopaedic-surgery-and-research","isVorOnly":false,"title":"Journal of Orthopaedic Surgery and Research"},"publishedOn":"2025-11-11 15:58:18","publishedOnDateReadable":"November 11th, 2025"},"versionCreatedAt":"2025-09-22 09:52:44","video":"","vorDoi":"10.1186/s13018-025-06422-7","vorDoiUrl":"https://doi.org/10.1186/s13018-025-06422-7","workflowStages":[]},"version":"v1","identity":"rs-7563726","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7563726","identity":"rs-7563726","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}