The role of arthroscopy in bullet removal: A systematic review of the literature

Abstract Purpose The purpose of this study was to systematically review the literature to gain a greater understanding of the role and usage of arthroscopy in removal of retained bullet fragments. Secondarily, we intend to examine the level of evidence and methodologic quality of studies reporting on this topic. Methods A search of PubMed, MEDLINE, and Cochrane Database of Systematic Reviews was performed using the search terms (“Arthroscopic” OR “Arthroscopy”) AND (“Bullet” OR “Gunshot” OR “Ballistic” OR “Removal”). Inclusion criteria included articles published in English reporting on arthroscopic or arthroscopically-assisted bullet removal. Studies lacking sufficient data to separate arthroscopic and open procedures were excluded. Level of evidence, study information (i.e., country, journal, etc.), and patient data was collected from each eligible article. The methodological index for non-randomized studies (MINORS) score were assigned to each article. Results A total of 2,676 studies were identified in the initial search with 31 studies meeting criteria for inclusion in the study. Twenty-eight of the 31 studies were case reports. The MINORS score averaged 8.8 ± 1.5 (range 5–10) for included studies. Sixty-two patients were identified, the majority (94%) of whom were male with an average age of 36.2 ± 12.3 years. All 62 patients underwent successful arthroscopic bullet removal. One patient was reported to have a complication (compartment syndrome). Outcome measures were underreported in the majority of studies. Conclusions Our study found that very little literature exists on the role of arthroscopy in bullet removal. Of this literature, no high-quality studies exist. Based on the limited existing literature, arthroscopy appears to be a safe, reliable alternative to open surgery for bullet removal. Potential benefits of arthroscopic bullet removal exist and warrant further investigation to further define the role of arthroscopy. Level of evidence Level V.