Open vs. Arthroscopic Repair for Anterior Instability: Which is Better?
Authors: C Bottoni
References: Practical Arthroscopy Newsletter september 2004
Dr Craig Bottoni reported on a randomised comparison of the two procedures carried out at the Tripler Army Medical Centre in Hawaii. He enrolled 60 patients with anterior instability who had failed six months of conservative treatment. All patients had an MR Arthrogram before and after surgery to evaluate the repair. The open surgery was done in the standard fashion with a subscap takedown and separation from the capsule. The Bankart was repaired with bio-absorbable anchors (Arthrex Bio-Fastak); a capsular shift was done if indicated. The arthroscopic repair was a similar technique with bio-absorbable anchors to repair the Bankart, and a capsular plication if there was no Bankart. The patients were followed over two years. There was a Bankart repair in 87% of the cases.
The operative time in the arthroscopic cases averaged 52 minutes compared to 163 minutes with the open procedures. The recurrence rate for subluxation and dislocation was lower in the arthroscopic group, 4% compared to 10% in the open. The open cases lost more range of external rotation.