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Arthroscopic shoulder stabilization: is there ever a need to open?
Eric J Kropf1, Fotios P Tjoumakaris, Jon K Sekiya
1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15203, USA.
Summary
Arthroscopic shoulder stabilization offers comparable results to open surgery, with decreasing contraindications. Sizable bone defects remain the only absolute contraindication for arthroscopic repair of shoulder instability.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Arthroscopy
Background:
- Arthroscopic shoulder stabilization techniques increasingly rival open Bankart reconstruction.
- Technical advancements allow arthroscopic treatment for conditions previously requiring open surgery.
- The universal application of arthroscopy prompts re-evaluation of indications for open surgery.
Purpose of the Study:
- To determine if open surgery is ever necessary for shoulder instability.
- To evaluate the role of normal anatomy and pathoanatomy in surgical decision-making.
- To compare the benefits and limitations of arthroscopic versus open shoulder stabilization.
Main Methods:
- Review of normal shoulder anatomy and pathoanatomy contributing to instability.
- Assessment of limitations in current arthroscopic techniques and instrumentation.
- Analysis of specific complicating factors in shoulder instability cases.
Main Results:
- Arthroscopy offers benefits like decreased morbidity and improved range of motion.
- Sizable glenohumeral bone defects are the primary contraindication for arthroscopic repair.
- Attenuated capsule, ligament avulsions, revision cases, and athlete type present challenges, not absolute contraindications.
Conclusions:
- The indications for open shoulder surgery are diminishing with arthroscopic advancements.
- Sizable bone defects are the sole absolute contraindication to all-arthroscopic shoulder stabilization.
- Complex cases require careful consideration of both arthroscopic and open approaches.
