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Stabilization for an Unstable Shoulder.
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Posted on: 08/28/2014
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The operative management for traumatic anterior shoulder instability has changed from open to arthroscopic techniques. Even though the surgical procedure has evolved there is still controversy over the results of open or arthroscopic shoulder stabilization. Advantages of arthroscopy are faster recovery, less postoperative pain, decreased operative time. improved cosmetic appearance, improved shoulder range of motion and more accurate identification of problems within the joint. Those that favor open procedures cite superior long-term results with fewer recurrences. This study wanted to find out the quality of life at two years, as measured by the Western Ontario Shoulder Instability Index (WOSI).(The WOSI is a tool form designed for self-assessment of shoulder function for people with instability).
In this study, dominant and non-dominant shoulders were operated on depending on the injured side. The time from injury to repair went up to 75 months. The average age of the patient was about 20 years old to 36 years old and both males and females underwent surgery.
In the post-operative findings, the WOSI scores improved significantly in both groups form baseline to two years after the either operation. On average there were slightly higher scores in the arthroscopic group but they were not significantly higher. Range of motion between the two procedures was similar between groups, with the arthroscopic repair group having slightly less outward rotation of the shoulder. An important finding was in the rate of recurrent instability was significantly lower in the open group than the arthroscopic group. At two years the difference in quality of life between the patients in the two groups was similar.
In the study a higher complication rate was found in the open surgery, but all patients recovered from the complications (transient nerve dysfunction and infections). Data in this study suggests a patient profile that is more likely to experience recurrent instability after surgery: male, twenty-five years old or younger, has a Hills-Sachs lesion ( an injury to the head of the bone of the arm). The study recommends considering an open repair for this group.
There was no significant difference that was found in quality of life between the patients who were operated on, as measured by the WOSI. The information in this study suggests that open repair may be recommended to reduce recurrent instability in younger male patients with a Hills-Sachs lesion.
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References:
Nicholas G.H. Mohtadi, MD,MSc,FRCSC, et al. A Randomized Clinical Trial Comparing Open and Arthroscopic Stabilization for Recurrent Traumatic Anterior Shoulder Instability. In The Journal of Bone and Joint Surgery. March 5, 2014. Vol.96A.No.5.Pp. 353-360.
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