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Comparison of Arthroscopic and Open Anterior Shoulder Stabilization A Two to Six-Year Follow-up Study*
Brian J. Cole, M.D.†; John L'Insalata, M.D.‡; Jay Irrgang, P.T., A.T.C.§; Jon J. P. Warner, M.D.#
View Disclosures and Other Information
Investigation performed at the University of Pittsburgh, Pittsburgh, Pennsylvania
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
†Department of Orthopaedics, Sports Medicine Section, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, 1725 West Harrison, Suite 1063, Chicago, Illinois 60612. E-mail address: bcole@ortho4.pro.rpslmc.edu.
‡9921 4th Avenue, Brooklyn, New York 11209.
§Center for Sports Medicine, University of Pittsburgh, Forbes Tower, Room 6060, Pittsburgh, Pennsylvania 15213.
#Harvard Shoulder Service, Massachusetts General Hospital, Partner's Department of Orthopaedic Surgery, Professional Office Building, Suite 403, 275 Cambridge Street, Boston, Massachusetts 02114. E-mail address: jwarner@partners.org.

J Bone Joint Surg Am, 2000 Aug 01;82(8):1108-1108
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Background: Sixty-three consecutive patients with recurrent traumatic anterior shoulder instability underwent operative repair. The decision to select either arthroscopic Bankart repair or open capsular shift was based on the findings of an examination under anesthesia and the findings at the time of arthroscopy. Thirty-nine patients with only anterior translation on examination under anesthesia and a discrete Bankart lesion underwent arthroscopic Bankart repair with use of absorbable transfixing implants. Twenty-four patients with inferior translation in addition to anterior translation on examination under anesthesia and capsular laxity or injury on arthroscopy underwent an open capsular shift.

Methods: Treatment outcomes for each group were determined according to the scoring systems of Rowe et al., the American Shoulder and Elbow Surgeons, and the Short Form-36. Failure was defined as recurrence of dislocation or subluxation or the finding of apprehension. Fifty-nine (94 percent) of the sixty-three patients were examined and filled out a questionnaire at a mean of fifty-four months (range, twenty-seven to seventy-two months) following surgery.

Results: There were no significant differences between the two groups with regard to the prevalence of failure or any of the other measured parameters of outcome. An unsatisfactory outcome occurred after nine (24 percent) of thirty-seven arthroscopic repairs and after four (18 percent) of twenty-two open reconstructions. All cases of recurrent instability resulted from a reinjury in a contact sport or a fall less than two years postoperatively. The treatment groups did not differ with regard to patient age, hand dominance, mechanism of initial injury, duration of follow-up, or delay until surgery. Measured losses of motion were minimal and, with the exception of forward elevation, slightly more of which was lost after the open capsular shifts (p = 0.05), did not differ between the two forms of treatment. Approximately 75 percent of the patients in each group returned to their favorite recreational sports with no or mild limitations. As rated by the patients, the result was good or excellent after thirty-one (84 percent) of the arthroscopic procedures and after twenty (91 percent) of the open procedures.

Conclusions: Arthroscopic and open repair techniques for the treatment of recurrent traumatic shoulder instability yield comparable results if the procedure is selected on the basis of the pathological findings at the time of surgery.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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