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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2007 April;58(2):143-61
Anterior shoulder instability. Evaluation and techniques of stabilisation
Johnson S. M., Robinson C. M.
The Shoulder Injury Clinic Royal Infirmary of Edinburgh Edinburgh, UK
Anterior dislocation of the gleno-humeral joint is a common injury of young men involved in contact sports and may progress to recurrent episodes of symptomatic instability. The accepted treatment following a primary dislocation involves a short period of immobilisation, followed by a rehabilitation programme and a gradual return to full activity. Open anterior shoulder stabilisation is a reproducibly successful procedure and remains the gold standard for the treatment of patients who develop recurrent instability. Arthroscopic shoulder surgery was initially utilised as a diagnostic tool, but it is now being increasingly used to perform therapeutic interventions and has resulted in a variety of minimally invasive techniques being advocated to treat shoulder instability. Arthroscopic stabilisation is commonly performed as a day-case procedure and offers attractive advantages over open repairs, including improved cosmesis, less postoperative pain, reduced postsurgical shoulder stiffness, and a quicker rehabilitation. In view of these advantages, the technique is now being offered as a primary treatment, following a first-time dislocation, in an attempt to prevent subsequent instability. However, the reported results following arthroscopic stabilisation have been much more variable than those for open repair. This review will examine recent advances in the understanding of the epidemiology and pathoanatomy of post-traumatic, anterior shoulder instability and will compare the relative merits of arthroscopic and open stabilisation in the management of this condition.