Arthroscopy effective for shoulder instability, but open surgery may be better for some

Arthroscopic surgery significantly increased shoulder stability even in patients who experienced postop episodes of instability.

Although arthroscopic surgery can effectively repair anterior shoulder instabilities, open surgery may still be more appropriate for certain patients because it can provide better postop stability, according to a prospective study by surgeons in Spain.

“Shoulders which were subjected to contact or overhead sports showed significantly higher probability of recurrence, and significant trauma involving a contact or overhead activity with the shoulder in abduction and external rotation was noted in all failed cases,” the authors of the study said.

“We recommend open stabilization for patients who wish to practice contact or overhead sports, but ... those athletes for whom it is essential to have a full range of movement in abduction and external rotation could be suitable for arthroscopic surgery,” they said.

Emilio Calvo Crespo, MD, and colleagues at the Fundación Jiménez Díaz, Madrid, evaluated the postop outcomes of Bankart arthroscopic shoulder repair in 61 patients with unidirectional anterior shoulder instability or glenohumeral instability.

Patients had a mean age of 27.5 years and were followed for an average of 44.5 months postop, with no patients followed for less than 24 months. All patients also underwent similar postoperative regimens.

Following surgery, the mean Rowe score, which rates function, stability, movement and pain, rose significantly to 86 points from 45 points preoperatively (P<.001). No patients experienced any major perioperative complications. Two patients did experience transient neurapraxia; however, these cases resolved without consequences within a few weeks, according to the study.

Of the 61 patients, the researchers noted excellent objective results in 42 (68.9%) and good results in eight (13.1%).

Among the remaining 11 patients (18%), seven had fair results (11.5%) and four (6.5%) had poor results, all of whom had at least one postop episode of shoulder instability. Surgery had significantly decreased the mean degree of shoulder instability in these patients (P=.018), however. Additionally, shoulder instability caused only two patients to not participate in sport activities, the authors said.

Using univariate analysis, the researchers found several factors related to postoperative failure, including: (1) age less than 28 years; (2) ligament laxity; (3) more than five preoperative dislocations; (4) presence of glenoid rim articular surface fractures greater than 15%; and (5) postoperative participation in contact or overhead sports.

However, only age, glenoid rim fractures and postop sports participation predicted the recurrence of shoulder instability, according to the study.

“The discrepancy between the higher recurrence rates in comparison with open surgery and the objective and subjective benefits of the procedure demand more precise arthroscopic surgery. In addition to technical improvements, it is essential to select patients carefully for this technique,” the authors said.

For more information:
Calvo E, Granizo JJ, Fernández-Yruegas D. Criteria for arthroscopic treatment of anterior instability of the shoulder. J Bone Joint Surg Br. 2005:87-B;677-683.