Evaluation of Spin Bias in Systematic Reviews and Meta-Analyses Comparing Bankart Repair with Remplissage Versus the Latarjet Procedure.

Authors

Emmanuel Olaonipekun, Michael Abdou, Ayomide Michael Ade-Conde, Sadhbh McCay, Colin Kruse, Marc Bouchard, Abdulaziz F Ahmed, Ashraf Hantouly, Moin Khan

Published in

Journal of shoulder and elbow surgery. Jul 15, 2026. Epub Jul 15, 2026.

Abstract

Anterior shoulder instability is common in young, active patients and, when managed surgically, is typically treated with either Bankart repair with remplissage or a bony procedure such as Latarjet. Both procedures have demonstrated favorable clinical outcomes, but differences in recurrent instability, complications, functional outcomes, and return-to-sport rates continue to be debated. In the setting of ongoing clinical equipoise and heterogeneous evidence, systematic reviews and meta-analyses may help guide treatment decisions. The aim of this study was to assess the prevalence of spin bias, defined as misrepresentation or overinterpretation of study findings, in the abstracts of systematic reviews comparing these procedures, and its potential influence on clinical decision-making.
A systematic review of systematic reviews and meta-analyses comparing arthroscopic Bankart repair with remplissage to the Latarjet procedure for anterior shoulder instability was conducted according to PRISMA guidelines and the Cochrane Handbook. MEDLINE, EMBASE, and the Cochrane Database of systematic reviews were searched from inception to October 29, 2025. Eligible studies were published in English and reported ≥1 clinical outcome. Abstracts were assessed independently in duplicate for 15 domains of spin while the methodological quality of included studies was evaluated using AMSTAR-2. Descriptive statistics were calculated, and exploratory comparisons were performed for studies with versus without the most common spin types.
Thirteen systematic reviews were included, seven of which incorporated meta-analyses, with a median of 16 primary studies and 778 shoulders per review. Spin was identified in 12 of 13 abstracts (92.3%), most related to misleading reporting (51.2%) and misleading interpretation (41.5%). Spin Types 5 (claims of benefit despite high risk of bias) and 12 (claims of equivalence despite non-significant results with wide confidence intervals) were most frequent (each 46.2%). No significant associations were identified between the presence of Type 5 or Type 12 spin and study characteristics. AMSTAR-2 assessments revealed ten systematic reviews with "critically low" and three with "low" methodological quality, primarily due to failure to report funding sources, assess the impact of risk of bias, and justify included study designs.
Spin is highly prevalent in abstracts of systematic reviews and meta-analyses comparing Bankart repair with remplissage to the Latarjet procedure. Most included systematic reviews were rated as low or critically low quality by AMSTAR-2, with abstract conclusions frequently overstating benefit or equivalence despite limited evidence. Clinicians should interpret these findings with caution when using systematic reviews to guide management of anterior shoulder instability.

PMID:
42457076
Bibliographic data and abstract were imported from PubMed on 16 Jul 2026.

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