This Article Full Text Full Text (PDF) [Supplementary Material] Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Reprints and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lenters, T. R. Articles by Matsen, F. A. Search for Related Content PubMed PubMed Citation Articles by Lenters, T. R. Articles by Matsen, F. A., III Related Collections Shoulder Social Bookmarking             What's this?

Arthroscopic Compared with Open Repairs for Recurrent Anterior Shoulder Instability

A Systematic Review and Meta-Analysis of the Literature

¹ Department of Orthopaedics and Sports Medicine (T.R.L., S.S.L, and
F.A.M. III), Box 356500, and Department of Medical Education and Biomedical
Informatics (F.M.W.), Box 357240, University of Washington
Medical Center, 1959 N.E. Pacific Street, Seattle, WA 98195. E-mail address for F.A. Matsen: matsen{at}u.washington.edu
² Aspen Orthopaedic and Rehabilitation, 19475 West North Avenue, Suite
201, Brookfield, WI 53045

Investigation performed at the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (DePuy) paid or directed in any one year, or agreed to pay or direct, benefits of less than $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated. (DePuy endowed a Chair in Shoulder Research, which is currently held by F.A. Matsen III.)

Methods: A systematic analysis of eighteen published or presented studies was performed to determine if there were significant differences between the two approaches with regard to recurrence (recurrent dislocation, subluxation, and/or apprehension and/or a reoperation for instability), return to work and/or sports, and Rowe scores. We also performed subgroup analysis to determine if the quality of the study or the arthroscopic technique influenced the results.

Results: We identified four randomized controlled trials, ten controlled clinical trials, and four other comparative studies. Results were influenced both by the quality of the study and by the arthroscopic technique. Meta-analysis revealed that, compared with open methods, arthroscopic repairs were associated with significantly higher risks of recurrent instability (p < 0.00001, relative risk = 2.37, 95% confidence interval = 1.66 to 3.38), recurrent dislocation (p < 0.0001, relative risk = 2.74, 95% confidence interval = 1.75 to 4.28), and a reoperation (p = 0.002, relative risk = 2.32, 95% confidence interval = 1.35 to 3.99). When considered alone, arthroscopic suture anchor techniques were associated with significantly higher risks of recurrent instability (p = 0.01, relative risk = 2.25, 95% confidence interval = 1.21 to 4.17) and recurrent dislocation (p = 0.004, relative risk = 2.57, 95% confidence interval = 1.35 to 4.92) than were open methods. Arthroscopic approaches were also less effective than open methods with regard to enabling patients to return to work and/or sports (p = 0.03, relative risk = 0.87, 95% confidence interval = 0.77 to 0.99). On the other hand, analysis of the randomized clinical trials indicated that arthroscopic repairs were associated with higher Rowe scores (p = 0.002, standardized mean difference = 0.43, 95% confidence interval = 0.16 to 0.70) than were open methods. Similarly, analysis of the arthroscopic suture anchor techniques alone showed the Rowe scores to be higher (p = 0.04, standardized mean difference = 0.29, 95% confidence interval = 0.01 to 0.56) than those associated with open methods.

Conclusions: The available evidence indicates that arthroscopic approaches are not as effective as open approaches in preventing recurrent instability or enabling patients to return to work. Arthroscopic approaches resulted in better function as reflected by the Rowe scores in the randomized clinical trials. The study design and the arthroscopic technique had substantial effects on the results of the analysis.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				L. A. Hiemstra, T. M. Sasyniuk, N. G. H. Mohtadi, and G. H. Fick Shoulder Strength After Open Versus Arthroscopic Stabilization Am. J. Sports Med., May 1, 2008; 36(5): 861 - 867. [Abstract] [Full Text] [PDF]

				C. M. Robinson, P. J. Jenkins, T. O. White, A. Ker, and E. Will Primary Arthroscopic Stabilization for a First-Time Anterior Dislocation of the Shoulder. A Randomized, Double-Blind Trial J. Bone Joint Surg. Am., April 1, 2008; 90(4): 708 - 721. [Abstract] [Full Text] [PDF]

				M. L. Ramsey, C. L. Getz, and B. O. Parsons What's New in Shoulder and Elbow Surgery J. Bone Joint Surg. Am., March 1, 2008; 90(3): 677 - 687. [Full Text] [PDF]

				K. A. Turman and M. D. Miller What's New in Sports Medicine J. Bone Joint Surg. Am., January 1, 2008; 90(1): 211 - 222. [Full Text] [PDF]

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2007 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.