title: Do arthroscopic and open stabilization techniques restore equivalent stability to the shoulder in the setting of anterior glenohumeral instability? a systematic review of overlapping meta-analyses.
abstract: OBJECTIVE
  Shoulder instability frequently recurs in young patients without operative treatment. Both open and arthroscopic approaches to shoulder stabilization with labral repair and capsulorrhaphy have been described and are routinely used. Multiple trials have been conducted to compare these approaches, with multiple meta-analyses performed to synthesize these trials; however, the results remain controversial. The purpose of this study was to critically evaluate the current meta-analyses to identify the current state of the art.
  
  
  METHODS
  In this study we evaluate available scientific support for the ability of both arthroscopic and open soft-tissue stabilization techniques to restore stability of the shoulder by performing a systematic review of the literature for previous meta-analyses. Data were extracted for rates of recurrence and patient outcomes. Study quality was measured with the Oxman-Guyatt and QUOROM (Quality of Reporting of Meta-analyses) systems. The Jadad algorithm was applied independently by 4 authors to determine which meta-analysis provided the highest level of available evidence.
  
  
  RESULTS
  After application of the inclusion and exclusion criteria, 8 meta-analyses were included. Both studies published prior to 2007 concluded that open stabilization provided lower recurrence rates than arthroscopic stabilization, the 3 studies published in 2007 are discordant, and all 3 studies published after 2008 concluded that open and arthroscopic stabilization provided equivalent results. Two meta-analyses had low Oxman-Guyatt scores (<3) signifying major flaws. Four authors independently selected the same meta-analysis as providing the highest quality of evidence using the Jadad algorithm, and this meta-analysis found no difference in recurrence rates between open and arthroscopic stabilization.
  
  
  CONCLUSIONS
  This systematic review of overlapping meta-analyses comparing arthroscopic and open shoulder stabilization suggests that according to current best available evidence, there are no significant differences in failure rates.
  
  
  METHODS
  Level IV, systematic review of Level I through IV studies.
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: p.n.chalmers@gmail.com.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Chalmers
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Randy
authors.initials: R
authors.lastname: Mascarenhas
authors.affiliation: Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Timothy
authors.initials: T
authors.lastname: Leroux
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A.
authors.forename: Eli T
authors.initials: ET
authors.lastname: Sayegh
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Nikhil N
authors.initials: NN
authors.lastname: Verma
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Cole
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Romeo
mesh_terms: D001182:Arthroscopy; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D015201:Meta-Analysis as Topic; D012008:Recurrence; D012783:Shoulder Dislocation / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome