Comparison Of Clinical And Patient-Reported Outcomes Of Three Procedures For Recurrent Anterior Shoulder Instability:Arthroscopic Bankart Repair,Capsular Shift And Open Latarjet

Objective:Recurrent anterior shoulder instability can be a disabling condition for the patients.However,the best surgical remained controversial.We knew little about the superiority and choice between traditional open and modem arthroscopic techniques.We hypothesized that the outcomes of all patients will be similar regardless of surgical technique.Methods:A retrospective case-cohort analysis of 102 patients who had recurrent anterior shoulder instability without bone defect underwent a surgical treatment from September 2013 to December 2015.All cases(mean age 30.8[range 18-50]years)were performed with arthroscopic bankart repair,open Latarjet,and capsular shift.The average follow-up was 57.6 months(range 36-72).There were 35 patients in the arthroscopic bankart repair group(22 males),26 patients in the open Latarjet group(17 males)and 30 patients in the capsular shift group(21 males).The average course of shoulder dislocation was 13 months;the shoulder instability index score(ISIS)was more than 3 with an average of 6.4.To compare the clinical efficacy of the three surgical treatments,patients were evaluated by satisfaction,subjective shoulder value(SSV),Subjective Shoulder Value for sport practice(SSV Sport),the American Shoulder and Elbow Joint Surgery Association shoulder joint score(ASES),Rowe score,UCLA score and extermal rotation(ER).Results:All treatments proved to be effective in improving shoulder flunctional status and reducing symptoms,while Latarjet had an advantage over subjective perception:The Rowe scores in arthroscopic bankart repair group,open Latarjet group and capsular shift group were respectively(92.3±1.5),(96.2±2.1)and(93.2±2.3)with significant difference.There was no significant difference in the other functional outcomes.However,Latarjet group in subjective results(SSV and SSV sport)was superior to the others(P<0.05).There were two relapsed cases in arthroscopic bankart group and capsular shift group and no recurrence in open Latarjet group.Conclusion:Arthroscopic bankart repair has the advantages of mini-invasion and rapid reeovery.Capsular shift has the advantages of low eost.Latarjet was more effective in reducing recurrence with higher stability.