Arthroscopic and open shoulder stabilization using absorbable implants A clinical and radiographic comparison of two methods

Abstract

The aim of this study was to compare the clinical and radiographic results in patients with recurrent unidirectional, post-traumatic shoulder instability (dislocations/subluxations). All the patients had a Bankart lesion and underwent reconstruction using either an open or an arthroscopic technique and absorbable implants. Thirty-three consecutive patients (36 shoulders) were operated on by one surgeon. Group A comprised 18 shoulders which underwent an open Bankart reconstruction using absorbable 3.7-mm TAG suture anchors. Group B comprised 18 shoulders which underwent a combination of an intra- and extra-articular arthroscopic stabilization using 8-mm Suretac fixators. The median number of dislocations before the reconstruction was 5 (0–45) in group A and 4 (0–30) in group B (NS). The follow-up examination was performed by an independent observer after a median of 31 (range 25–38) months in group A and 28 (range 18–46) months in group B (NS). An independent radiologist without any knowledge of the surgical procedure evaluated all the radiographs. There were no re-dislocations in either group. In group A, the Rowe and Constant scores were 86 (range 61–98) and 89 (range 73–99), respectively. The corresponding values in group B were 92 (range 83– 98; P = 0.05) and 96 (range 75– 100; NS). The external rotation in abduction was 65° (range 20°–90°) in group A and 83° (range 65°–105°) in group B (P = 0.0017). The radiographs revealed that 10/18 (56%) in group A and 4/18 (23%) in group B had visible drill-holes or cystic formations in conjunction with the drill-holes (P = 0.002). In this study the open procedure resulted in a restriction in external rotation more frequently than the arthroscopic procedure. The radiographs revealed visible drill-holes or cystic formations in conjunction with the drill-holes more frequently when TAG suture anchors were used than when Suretac fixators were used. The radiographic changes did, not appear to affect the clinical outcome, however.