Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Archives of orthopaedic and trauma surgery
Shoulder injuries in rugby union: a systematic review and meta-analysis
Shoulder injuries are common in Rugby Union, resulting in prolonged absence and considerable burden. Reported incidence, severity, and mechanisms vary widely, reflecting the multiple high-impact actions in the sport. Various management approaches exist to treat a wide range of pathologies. This systematic review and meta-analysis aimed to synthesise evidence on the epidemiology, mechanisms, and treatment of shoulder injuries in rugby. PUBMED, SCOPUS, and WEB OF SCIENCE were searched from database inception until 1st June 2025. From 1,099 abstracts screened, 37 studies were included. The pooled match incidence was 11.02 injuries/1,000 player-hours (95% CI 7.23-16.82), though heterogeneity was very high (I² = 97%) and the 95% prediction interval was wide (2.11-57.61 injuries/1,000 player-hours), indicating the pooled rate should be read as an average across diverse populations rather than a single representative value. Higher rates were seen in male elite (13.74/1,000 h) and high school/university players (12.28/1,000 h). Training incidence was considerably lower (0.20/1,000 h). Substantial between-study heterogeneity was observed across all incidence analyses, reflecting genuine variation across playing levels, sex, and surveillance methods. Tackling was the predominant injury mechanism, most often affecting the tackler. Bankart, Latarjet, and Bristow procedures all produced favourable reported outcomes for surgical management of anterior shoulder instability. These were indirect comparisons drawn from observational cohorts, however, and comparative effectiveness between techniques cannot be determined from the available evidence. Shoulder injuries in rugby occur far more often in matches than in training, result in prolonged time loss, and are most sustained in tackling. Surgical stabilisation is associated with favourable reported outcomes, though the comparative findings should be regarded as hypothesis-generating, and high-quality comparative studies are warranted. Greater attention to prevention, improved reporting of mechanisms, and focused research on female players should be prioritised.
31 July 2026
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A conceptual framework for measuring AI health equity
BACKGROUND: Artificial intelligence (AI) is increasingly embedded in health systems globally and has the potential to improve efficiency, diagnostic accuracy, and decision support. However, its benefits remain unevenly distributed, particularly in low- and middle-income countries (LMICs). Models developed using datasets from specific populations may perform poorly in other settings, reinforcing structural inequities rather than correcting them. OBJECTIVE: This viewpoint proposes a composite framework, the AI in Healthcare Equity Index (AIHEI), to support measurable assessment of equity in health AI systems. FRAMEWORK: The AIHEI is designed to assess equity across five domains: data representation, algorithmic fairness, transparency and explainability, governance and oversight, and community impact and benefit sharing. By generating a standardised score, the index could enable comparisons across technologies, incentivise improvement, and support regulation, procurement, publication, and funding decisions. IMPLICATIONS: Pilots across diverse health domains and geographic settings are needed to assess feasibility, refine domain weighting, and evaluate reliability, reproducibility, and validity. Important challenges include contextual definitions of fairness, data sovereignty, post-deployment monitoring, and the risk of metric gaming. CONCLUSIONS: Quantifying equity in health AI is essential to ensure that AI does not create, widen, or exacerbate existing disparities by neglecting underserved populations. A common, objective measure of AI-related health equity can help move the field from ethical aspiration toward measurable accountability, monitoring, and enforcement.
25 July 2026
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