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.