Comparison of open repair and arthroscopic repair results for anterior shoulder instability

Objective: The aim of this study is to compare retrospectively effectiveness of stability, functional capacity, duration of return to work and osteoarthiritis in open and arthroscopic surgical repair methods of anterior glenohumeral instability.Materials and Methods: Patients who underwent operation on anterior glenohumeral instability were retrospectively evaluated at Gazi University Faculty of Medicine, Department of Orthopaedics and Traumatology between January 1999 and December 2006. Total 53 patients who have adequate data and follow-up in open and arthroscopic groups were evaluated. 25 Patients underwent open Bankart repair with suture anchors between January 1999 and December 2004 and 28 patients underwent arthroscopic repair also with suture anchor between February 2004 and December 2006 included in this study. There were 23 male and two female patients in open repair group with average age of 29.1 (between 19-38). There were 24 male and four female patients in arthroscopic repair group with average age of 25.4 (between 15-48). Right hand was dominant hand for all patients. Open surgical treatment was performed for 11 patients (44%) to the right side and 14 patients (56%) to the left side. Arthroscopic surgical treatment was performed for 14 patients (50%) to the right side and 14 patients (50%) to the left side. The average duration of follow-up in open repair group was 78.5 months (between 42-103 months) and in arthroscopic repair group was 29.5 months (between 18-52 months).Results: Initially demographic variables in two groups were compared. Then recurrent dislocation, duration of return to work, osteoarthritis, range of motion and Oxford, Rowe and Constant scores for functional capacity were evaluated and compared within two groups. In this study, number of previous dislocation, presence of laxity, number of anchors and additional pathology (SLAP lesion, cartilage Bankart lesion and ALPSA lesion) were investigated to determine if the risk factors affected recurrent glenohumeral dislocation and also functional results were investigated if number of previous dislocation influenced the results. Between two groups there were quite similarities in sex, age, dominant side, presence of laxity, direction of instability (anterior) and occurrence mechanism (trauma), size of Hill-Sachs lesion (less than 30%) and number of anchors. We found that there was not significant difference between two groups. Recurrent glenohumeral dislocation rate in open surgical group was 4% and in arthroscopic surgical group was 7.1% but statistical significance was not found. Duration of return to work, osteoarthiritis, range of motion and Oxford, Rowe and Constant scores in arthroscopic group were resulted in better function and were found statistically significant in both groups. In this study any risk factor was not found for recurrent dislocation and clinical results in five patients who had first-time dislocation were found excellent and number of previous dislocation negatively affected the clinical results. The average duration of follow-up in open group was 78.5 (42-103) months and in arthroscopic group 29.5 (18-52) months. Duration of follow-up was found significant in both groups ( p < 0.001).Conclusions: Open Bankart repair has been used widely over decades with success by many orthopaedic surgeons. In last decade shoulder artroscopy has gained popularity and the technique has been evolved and became widely used by many orthopaedic surgeons. Besides the noninvasive technique of the shoulder arthroscopy it has some important advantages over open procedures. During arthroscopic surgery other lesions like SLAP lesions and posterior labral lesions can be viewed and addressed during the same procedure. In this study, arthroscopic repairs were found to be as effective as open repairs for the treatment of an anterior glenohumeral instability regardless the number of preoperative dislocations. Although arthroscopic repairs regained functional capacity earlier than open repairs both methods had excellent functional results. We concluded that arthroscopic surgical repair and open surgical repair are reliable methods in talented hands.