Arthroscopic versus open repair for traumatic anterior shoulder instability: a meta-analysis.
OBJECTIVE
The purpose of this study was to critically evaluate the literature to determine whether open or arthroscopic surgical repair for traumatic recurrent anterior shoulder instability results in a better outcome.


METHODS
Meta-analysis.


METHODS
The search involved clinical studies in all languages in the MEDLINE database from 1966 to October 31, 2003. The following key words were used: (1) anterior shoulder instability, (2) Bankart lesion, (3) traumatic recurrent anterior shoulder instability, and (4) arthroscopic and open Bankart repair. All abstracts were reviewed and articles were included if there was a direct clinical comparison between arthroscopic and open repair for traumatic recurrent anterior shoulder instability. These articles were manually cross-referenced for additional abstracts. The final group of articles was independently critically appraised and the following outcomes were extracted: recurrent instability, return to activity, reoperation rate, and cause of recurrence.


RESULTS
The search terms resulted in 677, 183, 68, and 51 hits respectively. From these, 18 articles were determined to be eligible for full review including 2 foreign-language articles. Cross-referencing identified 2 unpublished studies. Eleven studies were included in the final analysis: 1 randomized trial, 2 pseudo-experimental designs, 4 prospective cohorts, 3 retrospective studies, and 1 case control study. Pooled Mantel-Haenszel odds ratio for recurrent instability and return to activity were 2.04 ( P = .003; 95% confidence interval, 1.27, 3.29) and 2.85 ( P = .004; 95% confidence interval, 1.40, 5.78), respectively, in favor of the open repair.


CONCLUSIONS
Based on this meta-analysis, open repair has a more favorable outcome with respect to recurrence and return to activity.


METHODS
Level III, Systematic Review of Level III (and II/I) Studies.
Mohtadi
Nicholas G H
NG
University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada. mohtadi@ucalgary.ca
Bitar
Ivan J
IJ
Sasyniuk
Treny M
TM
Hollinshead
Robert M
RM
Harper
Wade P
WP
D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D019637:Orthopedic Procedures; D012785:Shoulder Joint / Q000601:surgery*