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Controversies in arthroscopic shoulder surgery: arthroscopic versus open bankart repair, thermal treatment of capsular tissue, acromioplasties—are they necessary?

      A significant debate has involved in the last several years regarding the optimal surgical management of glenohumeral instability. The majority of patients with traumatic anterior-inferior instability sustain a capsulolabral detachment
      • Taylor D.C.
      • Arciero R.A.
      Pathologic changes associated with shoulder dislocations arthroscopic and physical examination findings in first time anterior dislocations.
      ,
      • Baker C.L.
      • Uribe J.W.
      • Whitman C.
      Arthroscopic evaluation of acute initial anterior shoulder dislocations.
      described by Perthes
      • Perthes G.
      Uber operationen bei haituellar schulterluxation.
      and Bankart.
      • Bankhart A.S.B.
      The pathology and treatment of recurrent dislocation of the shoulder joint.
      The open Bankart repair by Rowe
      • Rowe C.R.
      • Patel D.
      • Southmayd W.W.
      The Bankart procedure a long-term end-result study.
      has resulted in a high rate of shoulder stability, although the functional outcome has sometimes been suboptimal, especially for higher-caliber athletes. Although suture anchors have simplified the procedure when compared with bone tunnels,
      • Levine W.N.
      • Richmond J.C.
      • Donaldson W.R.
      Use of suture anchor in open Bankart reconstruction. A follow-up report.
      the technique has not changed substantially. In an effort to decrease the morbidity and improve the functional results, Caspari
      • Caspari R.B.
      Arthroscopic reconstruction of anterior shoulder instability.
      ,
      • McIntyre L.F.
      • Caspari R.B.
      The rationale and technique for arthroscopic reconstruction of anterior shoulder instability using multiple sutures.
      developed an arthroscopic capsular shift technique, which began a period of intense interest and study in arthroscopic techniques to stabilize the shoulder. As refinements have been made to the arthroscopic methods, the number of proponents has grown. Current arthroscopic techniques using suture anchors
      • Wolf E.M.
      • Wilk R.M.
      • Richmond J.L.
      Arthroscopic Bankart repair with suture anchors.
      mimic the open Bankart repair and comparable results have been reported.
      • Bacilla P.
      • Field L.D.
      • Savoie F.H.
      Arthroscopic Bankart repair in a high-demand patient population.
      ,
      • Burkhart S.S.
      • De Beer J.F.
      Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs significance of the inverted-pair glenoid and the humeral engaging Hill-Sachs lesion.
      ,
      • Sperber A.
      • Hamberg P.
      • Karlsson J.
      • et al.
      Comparison of an arthroscopic and an open procedure for posttraumatic instability of the shoulder a prospective, randomized multicenter study.
      ,
      • Warner J.J.P.
      Treatment options for anterior instability open versus arthroscopic.
      Rather than attempt to defend a particular position as to whether an arthroscopic or an open approach to shoulder stabilization is best, the focus here is placed on what we have learned regarding the appropriate indications for each of these techniques.
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      References

        • Taylor D.C.
        • Arciero R.A.
        Pathologic changes associated with shoulder dislocations.
        Am J Sports Med. 1997; 25: 306-311
        • Baker C.L.
        • Uribe J.W.
        • Whitman C.
        Arthroscopic evaluation of acute initial anterior shoulder dislocations.
        Am J Sports Med. 1990; 18: 25-28
        • Perthes G.
        Uber operationen bei haituellar schulterluxation.
        Dtsch Zischierchi. 1906; 85: 199
        • Bankhart A.S.B.
        The pathology and treatment of recurrent dislocation of the shoulder joint.
        Br J Surg. 1938; 26: 23-29
        • Rowe C.R.
        • Patel D.
        • Southmayd W.W.
        The Bankart procedure.
        J Bone Joint Surg Am. 1978; 60: 1-16
        • Levine W.N.
        • Richmond J.C.
        • Donaldson W.R.
        Use of suture anchor in open Bankart reconstruction. A follow-up report.
        Am J Sports Med. 1994; 22: 723-726
        • Caspari R.B.
        Arthroscopic reconstruction of anterior shoulder instability.
        Tech Orthop. 1988; 3: 59-66
        • McIntyre L.F.
        • Caspari R.B.
        The rationale and technique for arthroscopic reconstruction of anterior shoulder instability using multiple sutures.
        Orthop Clin North Am. 1993; 24: 55-58
        • Wolf E.M.
        • Wilk R.M.
        • Richmond J.L.
        Arthroscopic Bankart repair with suture anchors.
        Oper Tech Orthop. 1991; 1: 187-191
        • Bacilla P.
        • Field L.D.
        • Savoie F.H.
        Arthroscopic Bankart repair in a high-demand patient population.
        Arthroscopy. 1997; 13: 51-60
        • Burkhart S.S.
        • De Beer J.F.
        Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs.
        Arthroscopy. 2000; 16: 677-694
        • Sperber A.
        • Hamberg P.
        • Karlsson J.
        • et al.
        Comparison of an arthroscopic and an open procedure for posttraumatic instability of the shoulder.
        J Shoulder Elbow Surg. 2001; 10: 105-108
        • Warner J.J.P.
        Treatment options for anterior instability.
        Oper Tech Orthop. 1995; 5: 233-237
        • Cole B.J.
        • Warner J.J.
        Arthroscopic vs open Bankart repair for traumatic anterior shoulder instability.
        Clin Sports Med. 2000; 19: 19-48
        • Kim S.H.
        • Ha K.I.
        • Kim S.H.
        Bankart repair in traumatic anterior shoulder instability.
        Arthroscopy. 2002; 18: 755-763
        • Weber S.C.
        A prospective evaluation comparing arthroscopic and open treatment of recurrent anterior glenohumeral dislocation.
        Orthop Trans. 1991; 15 (abstr): 763
        • Mologne T.S.
        • McBride M.T.
        • Lapoint J.M.
        Assessment of failed arthroscopic labral repairs. Findings as open surgery.
        Am J Sports Med. 1997; 25: 813-817
        • Kirkley A.
        • Griffin S.
        • Richards C.
        • Miniaci A.
        • Montadi N.
        Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization in first traumatic anterior dislocations of the shoulder.
        Arthroscopy. 1999; 15: 507-514
        • Bottoni C.R.
        • DeBernardino T.M.
        • Wilckens J.H.
        • D’Alleyrand J.C.
        A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment of acute, traumatic, first-time shoulder dislocation.
        Arthroscopy. 2000; 16 (abstr): 432
        • Abrams J.S.
        • Savoie III, F.S.
        • Tauro J.C.
        • Bradley J.P.
        Recent advances in the evaluation and treatment of shoulder instability.
        Arthroscopy. 2002; 18: 1-13
        • Wolf E.M.
        • Eakin C.L.
        Arthroscopic capsular plication for posterior shoulder instability.
        Arthroscopy. 1998; 14: 153-163
        • Antoniou J.
        • Duckworth D.T.
        • Harryman III, D.T.
        Capsulolabral augmentation for the management of posteroinferior instability of the shoulder.
        J Bone Joint Surg Am. 2000; 82: 1220-1230
        • Lu Y.
        • Hayashi K.
        • Edwards R.B.
        • Fanton G.S.
        • Thabit G.
        • Markel M.D.
        The effect of monopolar radiofrequency treatment patten on joint capsular healing.
        Am J Sports Med. 2000; 28: 711-719