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      Systematic Review of Arthroscopic Versus Open Repair for Recurrent Anterior Shoulder Dislocations

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          Abstract

          Context:

          It remains unknown if arthroscopic repair of recurrent anterior shoulder instability is as effective as open repair.

          Objective:

          The purpose of this study is to analyze the literature to provide clinical recommendations regarding the most appropriate therapeutic intervention for recurrent anterior shoulder instability.

          Study Design:

          Systematic review of level I and II studies.

          Data Sources:

          PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and secondary references from 1967 to March 2010 were appraised for studies that met the inclusion criteria.

          Study Selection:

          Inclusion criteria were English-language level I or level II trials involving the treatment of recurrent anterior shoulder instability. Exclusion criteria included non-English-language studies; level III, IV, or V studies; and trials examining treatment of first-time shoulder dislocation, posterior shoulder dislocation, or diagnoses other than recurrent anterior shoulder dislocations.

          Data Extraction:

          Included studies underwent quality appraisal independently by each author identifying strengths, weaknesses, and biases.

          Results:

          Four randomized controlled trials compared the use of arthroscopic and open repair for recurrent anterior shoulder dislocations. These studies show no statistically significant difference between the 2 operative approaches. No long-term follow-up data describing the effects of either surgical approach are available at this time. Each investigation had weaknesses in study design that decreased the validity of its findings.

          Conclusions:

          While limited, the available evidence from randomized controlled trials does not show a statistically significant difference in redislocation rates, return to activity, and functional outcomes between the arthroscopic and open repair groups. Range of motion is marginally better following arthroscopic treatment when compared with open repair. Recommendations on the optimal surgical intervention cannot be provided.

          Related collections

          Most cited references51

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          A clinical method of functional assessment of the shoulder.

          Several methods have been devised to estimate shoulder function, none of which is entirely satisfactory. The method described in this article is applicable irrespective of the details of the diagnostic or radiologic abnormalities caused by disease or injury. The method records individual parameters and provides an overall clinical functional assessment. It is accurately reproducible by different observers and is sufficiently sensitive to reveal even small changes in function. The method is easy to perform and requires a minimal amount of time for evaluation of large population groups.
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            The Bankart procedure: a long-term end-result study.

            Of 161 patients with 162 shoulders operated on during a thirty-year period (1946 to 1976), 124 were re-examined and twenty-one answered a questionnaire. The lesions found at surgery were separation of the capsule from the anterior glenoid rim in 85 per cent, a Hill-Sachs lesion of the humeral head in 77 per cent, and damage to the anterior glenoid rim (including fracture) in 73 per cent. There were five recurrences (3.5 per cent) after repair by the method described in the 145 shoulders that were followed. Only one of the forty-six patients with dislocation on the dominant side and one of the thirty-one with dislocation on the non-dominant side failed to return to the competitive athletic activities in which they participated prior to injury. The results at follow-up were rated excellent in 74 per cent, good in 23 per cent, and poor in 3 per cent. Ninety-eight per cent of the patients rated their result as excellent or good. Sixty-nine per cent of the shoulders had a full range of motion, and only 2 per cent of these shoulders redislocated. A fracture of the rim of the glenoid did not increase the risk of recurrence, while a moderate to severe Hill-Sachs lesion increased the risk only slightly. We concluded that with the meticulous technique of the Bankart repair as described, postoperative immobilization is not necessary, early return of motion and function can be expected, and resumption of athletic activities with no limitation of shoulder motion is possible for most patients.
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              • Record: found
              • Abstract: not found
              • Article: not found

              Prognosis in dislocations of the shoulder.

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                Author and article information

                Journal
                Sports Health
                Sports Health
                SPH
                spsph
                Sports Health
                SAGE Publications (Sage CA: Los Angeles, CA )
                1941-7381
                1941-0921
                July 2011
                July 2011
                : 3
                : 4
                : 396-404
                Affiliations
                [* ]University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
                []Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
                Author notes
                [*] []Address correspondence to Jon K. Sekiya, MD, MedSport, Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106 (e-mail: sekiya@ 123456umich.edu )
                Article
                10.1177_1941738111409175
                10.1177/1941738111409175
                3445197
                23016034
                33d60342-b22b-4bba-9085-07f74e9830cb
                © 2011 The Author(s)
                History
                Categories
                Orthopaedic Surgery
                1
                31
                39
                42
                115
                Custom metadata
                July/August 2011

                Sports medicine
                repair,arthroscopic,open,systematic review,recurrent anterior shoulder instability
                Sports medicine
                repair, arthroscopic, open, systematic review, recurrent anterior shoulder instability

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