Comparison of Open and Arthroscopic Stabilization for Recurrent Shoulder Dislocation in Patients with a Bankart Lesion

Abstract

We performed a prospective study of 117 patients (119 shoulders) with symptomatic, recurrent anterior posttraumatic shoulder instability to compare open versus arthroscopic reconstruction. Arthroscopic reconstructions (N = 66) were performed using bioabsorbable tacks (Suretac fixators), whereas open reconstructions (N = 53) were performed with suture anchors. All of the patients had a Bankart lesion. Independent observers examined 108 of the 119 shoulders (91%) at a median follow-up period of 28 months (range, 24 to 63) for the arthroscopic group and 36 months (range, 24 to 63) for the open group. The recurrence rate, including both dislocations and subluxations, was 9 of 60 (15%) in the arthroscopic group, compared with 5 of 48 (10%) in the open group. At follow-up, the Rowe score was 93 points (range, 39 to 100) and the Constant score was 91 points (range, 56 to 100) in the arthroscopic group, compared with 89 points (range, 53 to 100 and 57 to 100 for the Rowe and Constant scores, respectively) for both scores in the open group. The only significant difference was in external rotation in abduction, which was 90 degrees (range, 50 degrees to 135 degrees) in the arthroscopic group and 80 degrees (range, 25 degrees to 115 degrees) in the open group. Both methods produced stable and well-functioning shoulders in the majority of patients.

Anterior shoulder instability: a review of pathoanatomy, diagnosis and treatment

“…A meta-analysis of 501 patients treated surgically for anterior shoulder instability using suture anchors (234 arthroscopic and 267 open) found similar rates of recurrent instability (6% versus 6.7%) and need for re-operation (4.7% and 6.6%) [49•]. Subjective evaluations show no significant difference between the two treatment methods, although loss of range of motion (notably external rotation) may be increased with open repairs [50][51][52]. Some have shown that patients treated with open techniques have a lower rate of recurrent shoulder dislocations or instability than those treated with arthroscopic techniques, with the caveat that almost half of those treated with open techniques had loss of external rotation (range 10-40°loss) [53].…”

Shoulder Instability: Management and Rehabilitation

“…Arthroscopic techniques for reattaching the labrum can be divided into three categories: (1) a transglenoid suture technique, 14,26,35,51,62,74,76 (2) arthroscopically delivered and tied suture anchors, 33,40,93 and (3) arthroscopically delivered biodegradable tacs. 4,12,25,26,28,51,52,86,92 A comparison of the reported rates of recurrent dislocation for each technique is made in the Table. Multidirectional Instability The most commonly performed and most successfully reported surgical procedure for multidirectional instability of the shoulder is an anterior capsular shift, an open procedure that involves the overlaying and thus shortening of the anterior and inferior capsule. 3,60,77 Closure of the capsular interval between the subscapularis and supraspinatus has been reported to be successful in a small series of patients with subluxation.…”

How Does External Rotation Bracing Influence Motion and Functional Scores After Arthroscopic Shoulder Stabilization?

“…The rate of stiffness in the early postoperative period is not known because previous studies, both historic and recent, have focused on the incidence of recurrent instability, a relatively longer-term outcome that led to the reporting of data at greater than 2 years after surgery [4,8,9,20]. To our knowledge, this is the first study to report ROM and functional scores over multiple time points during the first year after surgery to assess the short-term recovery of ROM and shoulder function in patients who used the ER brace.…”