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Saturday, February 26, 2005

Arthroscopic and open shoulder stablization have similar outcomes, according to study

Although traditional open Bankart repair and capsulorrhaphy has been considered the gold standard for treating recurrent anterior glenohumeral instability, arthroscopic repair can have similar clinical results, according to presenters for Paper 155, who conducted a prospective randomized clinical trial comparing the two approaches.

Between April 2001 and September 2002, 64 consecutive patients with recurrent anterior shoulder instability who had failed nonoperative treatment were randomized to arthroscopic (A) or open (O) stabilization groups. Three patients were lost to follow-up. Bioabsorbable suture anchors were used in both groups.

Both groups followed the same postoperative rehabilitation protocol. Clinical evaluation included the Single Assessment Numeric Evaluation (SANE) score, the Western Ontario Stability Index (WOSI), the Simple Shoulder Test (SST), the University of California/Los Angeles (UCLA) evaluation and the Rowe score (measuring function, stability and range of motion). Postoperative failure was defined as recurrent dislocation, symptomatic subluxation or symptoms precluding return to full active duty.

A total of 61 patients (60 males, 1 female) made up the evaluation group: 32 had arthroscopic surgery and 29 had open surgery. Follow-up for all patients averaged 28 months. There were three failures-two in the open group and one in the arthroscopic group-based on the established criteria.

The average preoperative SANE score for all shoulders was 53.3; the mean postoperative score was 92.0. The average postoperative SANE, WOSI, SST, UCLA and Rowe scores for the arthroscopic group were higher than those of the open shoulders, but these differences were not statistically significant.

"Our unique military population allows for the evaluation of a homogenous group of athletes that has high demands on their shoulders. They tend to be very compliant in their rehabilitation, and our closed system ensured compliance with supervised physical therapy," said the authors. "Arthroscopic labral repair augmented with suture pilcation closely mimics the open Bankart repair technique with capsulorrhaphy. If both techniques yield comparable results, we recommend the use of arthroscopic repair for the treatment of recurrent anterior shoulder instability."

Researchers included LTC Craig R. Bottoni, MD; MAJ Eric L. Smith, MD; MAJ Mark J. Berkowitz, MD; and CDR Robert B. Towle, MD, all of Tripler Army Medical Center, Honolulu, Hawaii.

Arthroscopic image of a Bankart lesion- an injury to the anterior capsulolabral ligament that occurs with an anterior dislocation.

Arthroscopic image of an arthroscopic Bankart repair. The arthroscopic knot is slid down against the tissue to repair the Bankart lesion to the anterior edge of the glenoid.

Arthroscopic image of a completed arthroscopic Bankart repair. Three sutures have been placed to secure the capsulolabral complex.

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