ARTHROSCOPIC VERSUS OPEN REPAIR FOR RECURRENT TRAUMATIC ANTERIOR SHOULDER INSTABILITY: A META-ANALYSIS

Abstract

This meta-analysis supports the conclusion that in patients with recurrent traumatic anterior shoulder instability, an open repair has a more favorable outcome with respect to recurrence and return to activity when compared to arthroscopic repair. More evidence from randomized clinical trials is required to either refute or substantiate this conclusion.

The purpose of this study was to evaluate the outcomes between arthroscopic and open repair for recurrent traumatic anterior shoulder instability.

The search involved clinical studies of all languages in the Medline database up to October 31, 2001. 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 comparison between arthroscopic and open repair for traumatic recurrent anterior shoulder instability. These articles were manually assessed and cross-referenced for additional abstracts. The final group of articles were independently critically appraised and data on recurrent instability and return to activity (RTA) was extracted.

Recurrent instability was defined as patient report of one or more subluxations and/or dislocations. RTA was not consistently defined in these articles and was based upon the available information.

1. 584,

2. 161,

3. 59 and

4. 44.

From these searches, sixteen articles were determined eligible for the meta-analysis including two foreign and two unpublished manuscripts. Ten studies were included in the final analysis: one RCT, two pseudo-experimental designs, four prospective cohorts, and three retrospective studies.

Pooled Mantel-Haenszel Odds Ratio for recurrent instability and RTA were 2.22 (p=0.002, 95%CI 1.36,3.65) and 2.85 (p=0.004, 95%CI 1.40,5.78) respectively, in favor of the open repair.

Based upon this meta-analysis open repair has a more favorable outcome with respect to recurrence and RTA.