Meta-Analysis of Surgical Reconstruction for Anterior Shoulder Instability: A Comparison of Arthroscopic and Open Techniques
Authors: M Metcalf et al.
References: Presented at AAOS 2003
Purpose: The purpose of this study is to compare open and arthroscopic techniques for recurrent anterior instability by performing a meta-analysis of the published reports. Methods: A Medline search was performed to identify all peer-reviewed series. Multidirectional instability or single dislocations were excluded. Open procedures were Bankart-type reconstructions. Arthroscopic series included: staple, transglenoid suture, bioabsorbable tack or anchor reconstruction. Variables included patient age, duration of symptoms, number of dislocations, redislocation and recurrent instability rates, percent external rotation loss, strength, pain scores, and percent of good or excellent results. Results: 724 patients had undergone an open procedure, compared to 1946 arthroscopic cases. Open procedures averaged a redislocation rate of 7.9%, external rotation loss of 11% and 91% good or excellent results compared to 18%, 5% and 80% for arthroscopic cases. All parameters were statistically different. However, there was statistically significant differences between subgroups. For arthroscopic reconstruction with suture anchors, the average redislocation rate was 9.4%, external range of motion loss was 2.4% and 92% of the patients achieved a good or excellent result. Arthroscopic reconstruction with suture anchors had statistically significant better results than transglenoid suture, staple or tack reconstruction. Summary: Meta-analysis demonstrated that early arthroscopic techniques, including staples, transglenoid suture and bioabsorbable tacks, have higher redislocation rates and lower percentage of patient that achieve a good or excellent result compared with the gold standard. However, reconstruction with suture anchors has shown equivalent rates of recurrence and less external rotation loss than open Bankart reconstruction.