title: Comparison between the results of open and arthroscopic repair of isolated traumatic anterior instability of the shoulder.
abstract: OBJECTIVE
  The aim of this study was to compare the early postoperative results of open and arthroscopic Bankart repair for isolated traumatic anterior instability of the shoulder.
  
  
  METHODS
  The study included 64 male patients who underwent surgery for traumatic recurrent anterior shoulder instability. Of these, 30 patients (mean age 25.1 years) underwent open Bankart repair and 34 patients (mean age 25.8 years) underwent arthroscopic Bankart repair. All the patients had labral tears on preoperative magnetic resonance scans and had complaints of instability even during daily activities. Patients with at least six dislocations were included in the study; patients with multidirectional instability were excluded. The mean time from the first trauma to surgical intervention was 4.4 years (range 1 to 24 years) in the open surgery group, and 3.8 years (range 1 to 17 years) in the arthroscopy group. Decision for surgical treatment was made based on limitation of activities because of fear of having a dislocation and on positive results of instability tests. Repair was performed using metal anchors in both groups. The clinical results were evaluated using the Rowe scale. The severity of pain on the first postoperative day was assessed using a visual analog scale (VAS). The mean follow-up period was 26.1 months (range 12 to 52 months) in the open surgery group, and 26.6 months (range 12 to 51 months) in the arthroscopic repair group.
  
  
  RESULTS
  The mean duration of operation was 2 hours for open surgery, and 2.5 hours for arthroscopic repair. The size of the incision was approximately 8 cm in the open surgery group, and 3 cm in the arthroscopic repair group. The mean Rowe scores were 90.2 and 91.6, being higher in the arthroscopic repair group. Clinical results of open surgery were excellent in 21 patients (70%), good in eight patients (26.7%), and poor in one patient (3.3%). In the arthroscopic repair group, the results were excellent in 27 patients (79.4%), good in five patients (14.7%), and poor in two patients (5.9%). All the patients with a poor result experienced redislocations due to traumatic falls 5 to 18 months after surgery. The mean VAS score was 5.0 ± 1.3 in the open surgery group, and 4.4 ± 1.3 in the arthroscopic repair group. Loss of external rotation was observed in 15 patients (20° in 8 patients, 10° in 4 patients, 5° in 3 patients) in the open surgery group, and in nine patients (20° in 3 patients, 10° in 6 patients) in the arthroscopic repair group. There were no significant differences between the two groups with respect to Rowe scores, VAS scores, range of motion, apprehension test results, and the incidence of recurrent instability.
  
  
  CONCLUSIONS
  Although, in the past, the results of arthroscopic repair were less satisfactory compared to open surgery, this condition has changed remarkably. The results of arthroscopic repair in our study were similar to those of open repair. We believe that, with enhanced experience and advances in arthroscopic repair techniques, arthroscopic treatment may outweigh open surgery.
authors.affiliation: Department of Orthopedics, GATA Haydarpaşa Training Hospital, İstanbul, Turkey. mahirogullari@yahoo.com
authors.forename: Mahir
authors.initials: M
authors.lastname: Mahiroğulları
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ozkan
authors.forename: Mustafa
authors.initials: M
authors.lastname: Akyüz
authors.forename: Ali Akin
authors.initials: AA
authors.lastname: Uğraş
authors.forename: Ahmet
authors.initials: A
authors.lastname: Güney
authors.forename: Mesih
authors.initials: M
authors.lastname: Kuşkucu
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000592:standards*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods / Q000592:standards*; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular; D012008:Recurrence; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult