Coracoid bone‐block versus soft‐tissue stabilization for anterior shoulder instability in professional athletes: A systematic review and meta‐analysis of return to play and recurrence rates
Riccardo D'Ambrosi, Katia Corona, Angelo De Crescenzo, Valentina Fogliata, Valentina Greco, Andrea Pautasso, Andrea Sessa, Enrico Bellato,Abstract
Purpose
Anterior shoulder instability is a common injury among professional athletes. Both soft‐tissue and bone‐block procedures are widely used for surgical stabilization, but it remains unclear whether one approach offers superior outcomes in terms of return to play (RTP) and recurrence. The purpose of this systematic review and meta‐analysis was to compare RTP rates, time to RTP and recurrence of instability between professional athletes treated with coracoid bone‐block procedures and those undergoing soft‐tissue stabilization.
Methods
A systematic search of PubMed, Embase and the Cochrane Library was conducted from database inception through August 2025 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines. Studies including professional athletes treated surgically for anterior shoulder instability were analysed. Pooled effect estimates were calculated using random‐effects models. Subgroup analyses compared bone‐block versus soft‐tissue stabilization for RTP, time to RTP and recurrence.
Results
Thirteen studies were included in the systematic review and meta‐analysis and of these, eight analysed soft‐tissue surgery and five coracoid bone block. The overall pooled RTP rate was 95.6% (95% confidence interval [CI], 88.2–99.8) in the coracoid bone‐block group and 95.9% (95% CI, 91.6–98.9) in the soft‐tissue group ( p = 0.781). No significant differences were found in the level of RTP between the two treatment groups ( p = 0.266). A shorter time to RTP was observed in the coracoid bone‐block group (166.24 days [95% CI, 116.05–238.13]) compared with soft‐tissue stabilization (271.09 [95% CI, 195.03–376.80]; however, this finding should be interpreted with caution due to overlapping CIs, borderline statistical significance and substantial heterogeneity. The overall recurrence rate was 4.8% (95% CI, 1.5–9.3) with no difference between coracoid bone‐block procedure (2.6% [95% CI, 0.0–8.7]) and soft‐tissue (6.9% [95% CI, 2.0−13.8]) ( p = 0.302).
Conclusion
Both coracoid bone‐block and soft‐tissue procedures allow professional athletes to achieve high RTP rates with low recurrence. No definitive differences between techniques can be established, particularly considering the low quality of evidence and the substantial heterogeneity across studies.
Level of Evidence
Level III, systematic review and meta‐analysis.