Open or arthroscopic shoulder stabilization – indications and patient selection

Arthroscopic shoulder stabilization is a widely accepted method. Very often, an arthroscopic treatment is preferred by patients and surgeons because it is minimally invasive, spares the subscapularis muscle, and because it enables better identification and treatment of associated pathological conditions, and decreases morbidity. Furthermore, recent studies have demonstrated that the results of arthroscopic treatment of recurrent traumatic anterior instability are comparable with those achieved historically with open procedures1-3. However, arthroscopy is not always effective and there are cases which require open surgical techniques. There is a variety of reports regarding recurrence rates after arthroscopic Bankart repair, depending on arthroscopic skill, but also on the severity of the instability4. Therefore, the patient selection plays an important role on the success rate. After the first traumatic dislocation, a closed reduction has to be done, and the shoulder is put in the sling for two weeks. This rule is indicated for the general population, but if we treat top athletes, sometimes an immediate arthroscopy is indicated. After the period of rehabilitation, some shoulders will remain unstable, and the dislocation can occur during swimming, jumping or even during sleeping. The redislocation rate in the general population is around 50 %5. In younger patients or those with hyperlaxity, the percentage is higher, even up to 80 % or 92 %6-9. In Germany, in 73 % of hospitals surgery will be indicated for active younger patients under 3010,11. In case of recurrent instability, surgical therapy must be considered. For young patients with 2-6 redislocations after traumatic dislocation, arthroscopic treatment is indicated. The lesion of the anterior labrum is called the Bankart lesion and has several forms. There are several arthroscopic techniques, which include placement of titanium or resorbable implants into the anterior glenoid rim, and labrum repair is performed (Figure 1). In decision making regarding the selection of the surgical technique, we try to perform an anatomical repair, either open or arthroscopic. Therefore, the glenoid labrum repair together with capsular shift is generally accepted as the “gold standard”. In patient selection, the first step is a careful clinical *Corresponding author: Radovan Mihelic, MD, PhD Clinic for Orthopaedic Surgery Lovran, Faculty of Medicine University of Rijeka Setaliste Marsala Tita 1, 51 415 Lovran, Croatia e-mail: radovan.mihelic@gmail.com Clinic for Orthopaedic Surgery Lovran, Faculty of Medicine University of Rijeka, Rijeka, Croatia