Comparison of arthroscopic and open anterior shoulder stabilization - A two to six-year follow-up study

Background: Sixty-three consecutive patients with recurrent traumatic anter ior shoulder instability underwent operative repair. The decision to select either arthroscopic Bankart repair or open capsular shift was based on the findings of an examination under anesthesia and the findings at the time o f arthroscopy, Thirty-nine patients,sith only anterior translation on exami nation under anesthesia and a discrete Bankart lesion underwent arthroscopi c Bankart repair with use of absorbable transfixing implants. Twenty-four p atients with inferior translation in addition to anterior translation on ex amination under anesthesia and capsular laxity or injury on arthroscopy und erwent an open capsular shift. Methods: Treatment outcomes for each group were determined according to the scoring systems of Rowe ct al,, the American Shoulder and Elbow Surgeons, and the Short Form-36, Failure was defined as recurrence of dislocation or subluxation or the finding of apprehension. Fifty-nine (94 percent) of the sixty-three patients were examined and filled out a questionnaire at a mean of fifty-four months (range, twenty-seven to seventy-two months) following surgery. Results: There were no significant differences between the two groups with regard to the prevalence of failure or any of the other measured parameters of outcome. An unsatisfactory outcome occurred after nine (24 percent) of thirty-seven arthroscopic repairs and after four (18 percent) of twenty-two open reconstructions. All cases of recurrent instability resulted from a r einjury in a contact sport or a fall less than two years postoperatively. T he treatment groups did not differ with regard to patient age, hand dominan ce, mechanism of initial injury duration of follow-up, or delay until surge ry. Measured losses of motion were minimal and, with the exception of forwa rd elevation, slightly more of which was lost after the open capsular shift s (p = 0.05), did not differ between the two forms of treatment. Approximat ely 75 percent of the patients in each group returned to their favorite rec reational sports with no or mild limitations. As rated by the patients, the result was good or excellent after thirty-one (84 percent) of the arthrosc opic procedures and after twenty (91 percent) of the open procedures. Conclusions: Arthroscopic and open repair techniques for the treatment of r ecurrent traumatic shoulder instability yield comparable results if the pro cedure is selected on the basis of the pathological findings at the time of surgery.