Arthroscopic Compared with Open Repairs for Recurrent Anterior Shoulder Instability

Lenters, Tim R.; Franta, Amy K.; Wolf, Fredric M.; Leopold, Seth S.; Matsen III, Frederick A.
February 2007
Journal of Bone & Joint Surgery, American Volume;Feb2007, Vol. 89-A Issue 2, p244
Academic Journal
Background: Both arthroscopic and open surgical repairs are utilized for the management of anterior glenohumeral instability. To determine the evidence supporting the relative effectiveness of these two approaches, we conducted a rigorous and comprehensive analysis of all reports comparing arthroscopic and open repairs. Methods: A systematic analysis of eighteen published or presented studies was performed to determine if there were significant differences between the two approaches with regard to recurrence (recurrent dislocation, subluxation, and/or apprehension and/or a reoperation for instability), return to work and/or sports, and Rowe scores. We also performed subgroup analysis to determine if the quality of the study or the arthroscopic technique influenced the results. Results: We identified four randomized controlled trials, ten controlled clinical trials, and four other comparative studies. Results were influenced both by the quality of the study and by the arthroscopic technique. Meta-analysis revealed that, compared with open methods, arthroscopic repairs were associated with significantly higher risks of recurrent instability (p < 0.00001, relative risk = 2.37, 95% confidence interval = 1.66 to 3.38), recurrent dislocation (p < 0.0001, relative risk = 2.74, 95% confidence interval = 1.75 to 4.28), and a reoperation (p = 0.002, relative risk = 2.32, 95% confidence interval = 1.35 to 3.99). When considered alone, arthroscopic suture anchor techniques were associated with significantly higher risks of recurrent instability (p = 0.01, relative risk = 2.25, 95% confidence interval = 1.21 to 4.17) and recurrent dislocation (p = 0.004, relative risk = 2.57, 95% confidence interval = 1.35 to 4.92) than were open methods. Arthroscopic approaches were also less effective than open methods with regard to enabling patients to return to work and/or sports (p = 0.03, relative risk = 0.87, 95% confidence interval = 0.77 to 0.99). On the other hand, analysis of the randomized clinical trials indicated that arthroscopic repairs were associated with higher Rowe scores (p = 0.002, standardized mean difference = 0.43, 95% confidence interval = 0.16 to 0.70) than were open methods. Similarly, analysis of the arthroscopic suture anchor techniques alone showed the Rowe scores to be higher (p = 0.04, standardized mean difference = 0.29, 95% confidence interval = 0.01 to 0.56) than those associated with open methods. Conclusions: The available evidence indicates that arthroscopic approaches are not as effective as open approaches in preventing recurrent instability or enabling patients to return to work. Arthroscopic approaches resulted in better function as reflected by the Rowe scores in the randomized clinical trials. The study design and the arthroscopic technique had substantial effects on the results of the analysis.


Related Articles

  • Arthroscopic Anterior Stabilization of the Shoulder. Seung-Ho Kim; Kwon-Ick Ha; Yang-Bum Cho; Byung-Dam Ryu; Irvin Oh // Journal of Bone & Joint Surgery, American Volume;Aug2003, Vol. 85-A Issue 8, p1511 

    Evaluates prospectively the surgical outcomes of arthroscopic repair of anterior capsulolabral lesions with use of suture anchors in a large series of patients who were followed for two to six years. Mean age of patients with traumatic recurrent anterior instability of the shoulder; Objective...

  • 360° arthroscopic capsular release in patients with adhesive capsulitis of the glenohumeral joint – indication, surgical technique, results. Jerosch, Joerg // Knee Surgery, Sports Traumatology, Arthroscopy;May2001, Vol. 9 Issue 3, p178 

    Adhesive capsulitis of the glenohumeral joint is said to be a self-limiting process. However, in some patients the disease can last much longer than 1 year, which may lead patients to more invasive treatment than merely undergoing physiotherapy. Other patients do not accept this severe...

  • Randomized controlled trial of arthroscopic electrothermal capsulorrhaphy with Bankart repair and isolated arthroscopic Bankart repair. McRae, Sheila; Leiter, Jeff; Subramanian, Kanthalu; Litchfield, Robert; MacDonald, Peter // Knee Surgery, Sports Traumatology, Arthroscopy;Feb2016, Vol. 24 Issue 2, p414 

    Purpose: Electrothermal arthroscopic capsulorrhaphy (ETAC) was introduced as an adjunct to shoulder stabilization surgery to address capsular laxity in the treatment of traumatic anterior dislocation. No previous RCT has compared arthroscopic Bankart repair with ETAC of the medial...

  • Effects of surgical management on multidirectional instability of the shoulder: a meta-analysis. Chen, Dong; Goldberg, Jerome; Herald, Jonathan; Critchley, Ian; Barmare, Arshad // Knee Surgery, Sports Traumatology, Arthroscopy;Feb2016, Vol. 24 Issue 2, p630 

    Purpose: The purpose of this study was to assess the effectiveness of arthroscopic and open surgical techniques on the treatment of shoulder multidirectional instability.Methods: Literature searches were conducted using the databases MEDLINE, Embase, ClinicalTrials.gov,...

  • The Bristow-Latarjet procedure, a historical note on a technique in comeback. Linde, J.; Wijngaarden, R.; Somford, M.; Deurzen, D.; Bekerom, M.; van der Linde, J A; van Wijngaarden, R; Somford, M P; van Deurzen, D F P; van den Bekerom, M P J // Knee Surgery, Sports Traumatology, Arthroscopy;Feb2016, Vol. 24 Issue 2, p470 

    The Bristow-Latarjet procedure is a well-known surgical technique designed to treat shoulder instability. In this procedure, the coracoid process is transferred to the glenoid rim, to serve as augmentation of an associated bony defect. Because long-term results following a soft tissue procedure...

  • Arthroscopic debridement of massive rotator cuff tears: negative prognostic factors. Klinger, Hans-Michael; Steckel, Hanno; Ernstberger, Thorsten; Baums, Mike // Archives of Orthopaedic & Trauma Surgery;May2005, Vol. 125 Issue 4, p261 

    Abstract Introduction The purpose of this study was to identify the factors that may lead to poor outcomes after arthroscopic debridement in massive rotator cuff tears. Materials and methods Thirty-three patients (10 women and 23 men) with massive, irreparable rotator cuff tears underwent...

  • Arthroscopic Surgery for Knee Arthritis Found to be Useless (once again).  // HealthFacts;Oct2008, Vol. 33 Issue 10, p1 

    The article cites several clinical trials conducted by the Canadian and American researchers that shown arthroscopic surgery is no better than conservative treatment for people with knee osteoarthritis. It examines all the trials, which people involved had moderate-to-severe osteoarthritis of...

  • Shoulder stiffness and rotator cuff repair. Papalia, Rocco; Franceschi, Francesco; Vasta, Sebastiano; Gallo, Andrea; Maffulli, Nicola; Denaro, Vincenzo // British Medical Bulletin;Dec2012, Vol. 104 Issue 1, p163 

    Introduction Shoulder stiffness is a frequent complication of surgical repair of rotator cuff tears. Post-operative stiffness negatively affects surgical outcomes leading to a substantial comorbidity and to the failure of surgical treatment. Also, a stiff shoulder could commonly be concomitant...

  • Research reviews.  // Acupuncture in Medicine;Dec2004, Vol. 22 Issue 4, p224 

    The article presents information on several research papers related to acupuncture. A study on the role of acupuncture during recovery from arthroscopic acromioplasty showed a positive effect for real acupuncture despite using a penetrating sham in the control group and having a relatively small...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics