Controversies in the Surgical Management of Shoulder Instability: Open vs Arthroscopic Procedures



Alejandro Huerta1, Gustavo Rincón1, Lluis Peidro2, Andreu Combalia2, Sergi Sastre2, *
1 Fellowship Universitat de Barcelona, Arthroscopy Department of Orthopaedic Surgery, Hospital Clínic, Barcelona, Spain
2 Orthopedic Surgeon, Orthopedic Surgery Hospital Clínic Barcelona, Italy


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© 2017 Huerta et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Orthopedic Surgeon, Orthopedic Surgery Hospital Clínic Barcelona, Italy; E-mail: sergi.sastre@gmail.com


Abstract

Background:

Traumatic anterior instability of the shoulder is a common condition associated with a high recurrence rate in young adults. Operative treatment reduces the risk of recurrence. Several studies have compared arthroscopic and open shoulder instability repair. The purpose of this paper is to perform a review of the literature where both techniques are compared in the repair of the anterior shoulder instability without bone loss.

Methods:

Prior to arthroscopy, recurrent dislocations were managed by open repair. There have been many studies documenting low recurrence rates after open Bankart stabilization.

Initially, arthroscopic fixation reported high failure rates.

Results:

In the last 20 years, the development of arthroscopic stabilization for recurrent anterior instability has improved failure rates. In comparison with open techniques, arthroscopic procedures have the advantages of decreased morbidity rate, early functional rehabilitation and improved range of motion.

Conclusion:

The available evidence does not show a statistically significant difference in outcome measures between arthroscopic and open repair for the treatment of recurrent anterior shoulder instability. Given the similar results between the 2 groups, differences in length of hospital stay and cost to the patient and society point to arthroscopic repair as the more judicious treatment approach.

Keywords: Shoulder dislocation, Shoulder instability, Open procedures, Arthroscopy.