Open and arthroscopic techniques for the treatment of traumatic anterior shoulder instability in Australian Rules football players

Australian Rules Football (ARF) is a potentially violent, overhead, body-co ntact sport. We reviewed 56 shoulders in patients who sustained their initi al traumatic anterior subluxation or dislocation during ARF and who underwe nt reconstructive surgery For traumatic anterior instability, whether by ar throscopic or by open techniques. Patients were followed up for a mean of 2 9.4 months after operation, and clinical evaluation was performed with the Rowe grading system. Three types of surgical procedures were performed: art hroscopic suture repair, arthroscopic Bankart repair with an absorbable pol yglyconate tack, and open capsular shift with repair of the Bankart lesion. Shoulders treated with arthroscopic suture repair had a 70% rate of recurr ent subluxation or dislocation on return to ARF. Dislocations treated arthr oscopically with the biodegradable tack had a 38% rate of recurrence of ins tability; three fourths of the recurrences were after minimal to moderate t rauma. Shoulders treated with an open capsular shift and Bankart procedure had a 30% rate of recurrent instability, with half of the recurrences cause d by violent trauma. In the open group there were no failures in patients w ho did not return to ARF. We suggest that arthroscopic repair in shoulders with anterior instability and recurrent dislocation does not adequately add ress the plastic deformation of the anterior capsule that may occur after r epeated episodes of dislocation. We advocate open shoulder procedures in AR F athletes to address all areas of the capsulolabral pathologic condition a nd to provide the most secure repair possible with minimal chance of recurr ence.