Recent advances and perspectives on arthroscopic stabilization of the shoulder

The goal of surgical stabilization of the unstable glenohumeral joint is to produce a stable yet mobile joint that can return to preinjury function. Open surgical procedures (in particular, the Bankart procedure) have evolved to a point where stability and mobility are being attained with a low complication rate, but the rate of return to preinjury function, particularly in overhead athletes, has not been ideal. Arthroscopic stabilization is an attractive alternative to open procedures, particularly in those patients who have a history of traumatic and unidirectional recurrent dislocations with a labral detachment. A variety of techniques for reattaching a detached labro-ligamentous complex have been described. Longer follow-up is needed to assess the efficacy of these procedures fully, particularly in light of the good results now being obtained with the open Bankart procedure. Longer-term studies have shown a higher rate of recurrence of dislocation with the arthroscopic technique than with the open technique. Arthroscopic stabilization offers the potential advantages of shorter hospitalization, less traumatic treatment of the soft tissues, more thorough examination of the glenohumeral joint and subacromial bursa, and greater cosmesis. It could also provide a means by which selective stabilization of those initial anterior dislocations that might be prone to recurrence could be performed. Long-term follow-up and randomized studies comparing open and arthroscopic techniques are needed to further define the best role of arthroscopic shoulder stabilization and to determine which of the several techniques described provides the best results with the fewest complications.