Comparison of Arthroscopic and Open Anterior Shoulder Stabilization: A Two- to Six-Year Follow-up Study.

Comparison of Arthroscopic and Open Anterior Shoulder Stabilization: A Two- to Six-Year Follow-up Study

Cole BJ, L'Insalta J, Irrgang J, Warner JJP (Department of Orthopaedics, Sports Medicine Section, Rush Medical College, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill; Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pa; Harvard Shoulder Service, Massachusetts General Hospital, Boston, Mass), J Bone Joint Surg Am. 2000; 82:1108-1114.

The purpose of this study was to assess the efficacy of arthroscopic Bankart repair or open capsular shift on patients with a history of anterior instability of the glenohumeral joint.

The researchers studied 63 patients with a history of traumatic anterior glenohumeral instability, all of whom required operative reconstruction. The decision of whether to repair the shoulder arthroscopically or to perform open capsulorraphy was based on examination findings obtained while each patient was under anesthesia. Thirty-nine patients who demonstrated translation under anesthesia and had a Bankart lesion underwent an arthroscopic repair. Twenty-four patients with anterior/inferior translation under anesthesia received a reconstruction with an open capsular shift procedure.

The authors were able to evaluate the outcome efficacy of 59 of the 63 patients (94%) at a mean of 54 months after the operation. The patients completed the American Shoulder and Elbow Surgeon's standardized assessment form, and they rated their functional capability according to the system devised by Rowe.

The authors reported no significant difference in any of the outcome measures between the 2 groups regardless of the procedure performed. Unsatisfactory outcomes (defined as recurrent dislocation or subluxation or a finding of apprehension) were reported by 9 of the patients who underwent arthroscopic Bankart repair (24%) and 4 of the patients who underwent open capsular shift (18%), respectively. All of the patients who reported an unsatisfactory outcome, however, reported an episode of traumatic stress to the shoulder during a contact sport or from a fall that resulted in a strain of the repair. Approximately 75% of patients in both groups reported minimal or no limitations when they returned to sports, resulting in their ability to resume recreational and competitive athletic activity at the same level that they had enjoyed prior to surgery. Eighty-four percent of those patients who underwent arthroscopic Bankart repair were satisfied with their recovery, and 91% of those who had open capsulorraphy expressed the same satisfaction.

Based on the examination results at the time of surgery, the authors concluded that performing arthroscopic Bankart repair and open capsular shift for the surgical management of traumatic glenohumeral instability yielded comparable results. They believed that appropriate procedure was selected commensurate with the pathological findings once the patient was anesthetized and could be examined clinically and arthroscopically.

Steve Hoffman, PT, ATC, SCS North Hills Orthopedic and Sports Physical Therapy Sewickley, Pa