2015 ISAKOS Biennial Congress ePoster #2311

Comparison of Clinical Outcomes Between Arthroscopic and Open Procedures for Traumatic Anterior Shoulder Instability in Collision and Contact Athletes: A Prospective Cohort Study Based on Patient Selection

Yoshiyasu Uchiyama, MD, PhD, Isehara, Kawagawa JAPAN
Eiji Shimpuku, MD, Hachioji JAPAN
Joji Mochida, Isehara-City JAPAN
Tokai University Hospital, Isehara, Kanagawa, JAPAN

FDA Status Cleared

Summary: We performed a prospective cohort trial in patients undergoing anterior shoulder stabilization in collision and contact athletes. The open procedure (0%) resulted in to a lower recurrent instability rate than the arthroscopic procedure (13.6%). Therefore, open stabilization may be a more reliable method for treating traumatic anterior shoulder instability in these athletes

Abstract:

Purpose

Collision and contact athletes are reported to have high risk for recurrent traumatic shoulder instability. We performed a prospective cohort trial to evaluate the results of anterior shoulder stabilization in collision and contact athletes and compared the clinical results between the arthroscopic Bankart repair and the open procedure known as the modified inferior capsular shift.
Materials & Methods: This prospective cohort study based on the patient selection method included 71 shoulders of 70 patients (male 62, female 8): open procedure, 26 shoulders of 26 patients and arthroscopic procedure, 45 shoulders of 44 patients, from 2007 to 2013. The rate of recurrent instability and limitations in external rotation (at the anatomical position and 90° abduction) were compared between procedures. In addition, preoperative and postoperative clinical Rowe and Constant scores were assessed within and between groups. Patients were followed up for an average duration of 24.8 months (range, 12–48 months).

Results

Recurrence rates in the arthroscopic repair group were higher than those in the open repair group (13.6% vs 0%, p=0.049). No significant difference in external rotation at the anatomical position was noted between the arthroscopic and open procedure groups (average 3.8° vs 5.6°, p=0.285). However, significant differences in external rotation at 90º abduction was noted between the groups (average 4.8° vs 11.2°, p=0.036). The Rowe and Constant scores at the final follow-up significantly improved from those preoperatively in both groups (both, p<0.05), but the differences in scores between the arthroscopic (average 86.8 and 87.5 points, respectively) and open procedures (average 88.9 and 89.3 points, respectively) groups were not statistically significant.

Conclusion

Our data clearly suggest that open procedure results in lower recurrent instability rates than the arthroscopic procedure. However, external rotation is relatively limited with open repair than with arthroscopic repair. The Rowe and Constant scores were not significantly different between the open and arthroscopic repair groups at the final follow-up. Thus, open stabilization may be a more reliable method for treating traumatic anterior shoulder instability in collision and contact athletes