The effectiveness of arthroscopic versus open shoulder stabilization in the management of traumatic anterior glenohumeral instability

Abstract

Objectives The objective of this systematic review is to compare the effect of arthroscopic stabilization with open surgical stabilization for the management of traumatic anterior glenohumeral instability. We aim to address the following questions that are of clinical interest: 1. Is arthroscopic stabilization equally effective as open surgical stabilization in the management of anterior glenohumeral instability for: a. The general population? b. Population sub-groups? 2. Are there any differences in the outcome of various arthroscopic techniques (suture anchors, bioabsorbable tacks, transglenoid sutures and metallic fixators) for shoulder stabilization, compared with open surgical stabilization? 3. What factors and prognostic indicators are considered when deciding between arthroscopic versus open surgical stabilization for the management of anterior glenohumeral instability? Criteria for considering studies for this review Types of participants Patients with traumatic anterior glenohumeral instability, confirmed by one or more of the following: a history of trauma precipitating anterior dislocation/subluxation, radiological evidence, clinical examination, examination under anaesthesia (EUA) and arthroscopy will be included. By definition, traumatic anterior glenohumeral instability may include first-time dislocators as well as patients with recurrent dislocations, subluxation or a positive apprehension test. Patient groups that are specifically 40 years and older will be excluded from the study because of a higher rate of associated rotator cuff pathology within this age-group. Patients with multidirectional instability and any other concomitant shoulder pathology will also be excluded to eliminate potential confounding factors that could affect the outcome of the stabilization procedures for the management of traumatic anterior glenohumeral instability. Types of interventions Interventions will include all types of arthroscopic shoulder stabilization techniques such as suture anchors, bioabsorbable tacks, transglenoid sutures and metallic fixators, with or without additional suture plication of the capsule, compared with open surgical shoulder stabilization techniques, for the management of traumatic anterior glenohumeral instability. Studies that applied non-anatomical surgical procedures i.e. Putti-Platt, Bristow will be excluded because, they do not correct the underlying pathological lesion; they alter normal shoulder kinematics; have high complication rates and are infrequently performed in clinical practice today. Types of outcome measures A minimum follow-up period of 2 years will be TRUNCATED AT 350 WORDS