Arthroscopic Versus Open Anterior Shoulder Stabilization: A Prospective Randomized Clinical Trial With 15-Year Follow-up With an Assessment of the Glenoid Being “On-Track” and “Off-Track” as a Predictor of Failure

Abstract

Background: Recent studies have demonstrated equivalent short-term results when comparing arthroscopic versus open anterior shoulder stabilization. However, none have evaluated the long-term clinical outcomes of patients after arthroscopic or open anterior shoulder stabilization, with inclusion of an assessment of preoperative glenoid tracking. Purpose: To compare long-term clinical outcomes of patients with recurrent anterior shoulder instability randomized to open and arthroscopic stabilization groups. Additionally, preoperative magnetic resonance imaging (MRI) studies were used to assess whether the shoulders were “on-track” or “off-track” to ascertain a prediction of increased failure risk. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A consecutive series of 64 patients with recurrent anterior shoulder instability were randomized to receive either arthroscopic or open stabilization by a single surgeon. Follow-up assessments were performed at minimum 15-year follow-up using established postoperative evaluations. Clinical failure was defined as any recurrent dislocation postoperatively or subjective instability. Preoperative MRI scans were obtained to calculate the glenoid track and designate shoulders as on-track or off-track. These results were then correlated with the patients’ clinical results at their latest follow-up. Results: Of 64 patients, 60 (28 arthroscopic and 32 open) were contacted or examined for follow-up (range, 15-17 years). The mean age at the time of surgery was 25 years (range, 19-42 years), while the mean age at the time of this assessment was 40 years (range, 34-57 years). The rates of arthroscopic and open long-term failure were 14.3% (4/28) and 12.5% (4/32), respectively. There were no differences in subjective shoulder outcome scores between the treatment groups. Of the 56 shoulders, with available MRI studies, 8 (14.3%) were determined to be off-track. Of these 8 shoulders, there were 2 surgical failures (25.0%; 1 treated arthroscopically, 1 treated open). In the on-track group, 6 of 48 had failed surgery (12.5%; 3 open, 3 arthroscopic [ P = .280]). Conclusion: Long-term clinical outcomes were comparable at 15 years postoperatively between the arthroscopic and open stabilization groups. The presence of an off-track lesion may be associated with a higher rate of recurrent instability in both cohorts at long-term follow-up; however, this study was underpowered to verify this situation.

Consideration May Be Given to Lowering the Threshold for the Addition of Remplissage in Patients With Subcritical Glenoid Bone Loss Undergoing Arthroscopic Bankart Repair

“…Fifth, the follow-up was short-term at 2 years postoperative, and recurrence can continue to occur at later time points. 32 Finally, a cost comparison was not practical based on the use of 4 international sites, and therefore we could not assess the value of each procedure.…”

Validação clínica do conceito de glenoid track na instabilidade glenoumeral anterior

“…Our study has some limitations. Magnetic resonance imaging (MRI) was used to measure the glenoid track; however, there is no validation in the literature for the use of such measure in this type of imaging examination, since it was developed for use in CT; it is noteworthy that Bottoni et al 30 in 2021 used MRI in the same way as us. The images were performed by only one orthopedist in a single period.…”

“…Nosso estudo tem algumas limitações. Utilizamos a RM para a aferição do glenoid track ; contudo, não há na literatura validação para o uso de tal medida nesse tipo de exame de imagem, visto que foi desenvolvido para o uso em TC; vale ressaltar que Bottoni et al, 30 em 2021, fizeram uso de RM da mesma forma que nós. Foi realizada a análise das imagens por apenas um médico ortopedista em um único período.…”

Arthroscopic Versus Open Anterior Shoulder Stabilization: Letter to the Editor

“…Regarding the recent article by Drs Bottoni et al, 1 “Arthroscopic Versus Open Anterior Shoulder Stabilization: A Prospective Randomized Clinical Trial With 15-Year Follow-up With an Assessment of the Glenoid Being ‘On-Track’ and ‘Off-Track’ as a Predictor of Failure,” the authors are to be commended on their attempt to provide long-term follow-up information on a cohort of military personnel with shoulder instability. It is very difficult to follow any group of patients for this length of time (15 years), especially those who were an average age of 25 at baseline.…”

“…We obtained follow-up for all 32 patients in the open stabilization cohort, including the 3 patients originally lost to follow-up in the index 32-month study. However, in the arthroscopic cohort, 3 patients were lost to follow-up and 1 was killed in combat, leaving 28 patients.” 1 A misclassification bias of this nature, given the fact that this is a small randomized trial, leads to more questions than answers. Blinding the assessors was not possible for the current study.…”