Comparison of an arthroscopic and an open procedure for posttraumatic instability of the shoulder: A prospective, randomized multicenter study

From 1993 through 1996, a multicenter study was conducted on the surgical t reatment of patients with posttraumatic recurrent anterior shoulder disloca tions. Fifty-six patients (40 men, 16 women; mean age 26 years [range 18-51 years]), were evaluated with shoulder arthroscopy. If a Bankart lesion was present, the patients were randomly allocated to either an arthroscopic re construction with the use of biodegradable tacks or an open reconstruction with suture anchors. The postoperative rehabilitation protocol for the two groups was identical. In all patients, the range of shoulder motion, stabil ity, and the Constant and Rowe scorer were evaluated at 3, 12, and 24 month s postoperatively. Thirty patients were surgically created with the arthros copic technique and 26 patients with the open technique. In the arthroscopi c group, there were recurrences in 7 (23%) of 30 patients at a mean of 13 m onths (range 5 to 21 months) after surgery. All patients with stable should ers had a negative apprehension test result. In the open group, there were recurrences in 3 (12%) of 26 patients at a mean of 10 months (range 2 to 23 months) after surgery (P = not significant). In the arthroscopic group, 2 patients had new traumatic redislocations, whereas 1 patient redislocated d uring an epileptic seizure. In the open group, 1 traumatic redislocation oc curred. The 2-year results in this study demonstrate a large number of redi slocations after reconstruction, even in the open surgery group. Patient no ncompliance with the rehabilitation protocol and predisposing disease may p artially explain these results. A tendency was seen toward more redislocati ons in the arthroscopic group, which emphasizes the importance of correct p atient selection and careful surgical technique in the difficult surgical p rocedure.