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 1 Taylor D.C. Arciero R.A. Pathologic changes associated with shoulder dislocations arthroscopic and physical examination findings in first time anterior dislocations. Am J Sports Med. 1997; 25: 306-311 Crossref PubMed Scopus (397) Google Scholar , 2 Baker C.L. Uribe J.W. Whitman C. Arthroscopic evaluation of acute initial anterior shoulder dislocations. Am J Sports Med. 1990; 18: 25-28 Crossref PubMed Scopus (251) Google Scholar described by Perthes 3 Perthes G. Uber operationen bei haituellar schulterluxation. Dtsch Zischierchi. 1906; 85: 199 Crossref Scopus (199) Google Scholar and Bankart. 4 Bankhart A.S.B. The pathology and treatment of recurrent dislocation of the shoulder joint. Br J Surg. 1938; 26: 23-29 Crossref Scopus (635) Google Scholar The open Bankart repair by Rowe 5 Rowe C.R. Patel D. Southmayd W.W. The Bankart procedure a long-term end-result study. J Bone Joint Surg Am. 1978; 60: 1-16 Crossref PubMed Scopus (1164) Google Scholar 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, 6 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 Crossref PubMed Scopus (92) Google Scholar the technique has not changed substantially. In an effort to decrease the morbidity and improve the functional results, Caspari 7 Caspari R.B. Arthroscopic reconstruction of anterior shoulder instability. Tech Orthop. 1988; 3: 59-66 Crossref Scopus (108) Google Scholar , 8 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 PubMed Google Scholar 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 9 Wolf E.M. Wilk R.M. Richmond J.L. Arthroscopic Bankart repair with suture anchors. Oper Tech Orthop. 1991; 1: 187-191 Abstract Full Text PDF Scopus (126) Google Scholar mimic the open Bankart repair and comparable results have been reported. 10 Bacilla P. Field L.D. Savoie F.H. Arthroscopic Bankart repair in a high-demand patient population. Arthroscopy. 1997; 13: 51-60 Abstract Full Text PDF PubMed Scopus (203) Google Scholar , 11 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. Arthroscopy. 2000; 16: 677-694 Abstract Full Text Full Text PDF PubMed Scopus (1317) Google Scholar , 12 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. J Shoulder Elbow Surg. 2001; 10: 105-108 Abstract Full Text Full Text PDF PubMed Scopus (121) Google Scholar , 13 Warner J.J.P. Treatment options for anterior instability open versus arthroscopic. Oper Tech Orthop. 1995; 5: 233-237 Abstract Full Text PDF Scopus (4) Google Scholar 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.