Posterior shoulder instability: comprehensive analysis of open and arthroscopic approaches

Whether open surgery and arthroscopic repair of posterior shoulder instability have similar success rates remains unknown, but the literature suggests that arthroscopic soft-tissue stabilization procedures equal open surgery in managing posterior shoulder instability. A comprehensive PubMed computer search of the English-language literature from 1988 to 2004 was performed using the key phrase posterior shoulder instability. Studies included in our analysis addressed the surgical treatment of recurrent posterior instability and multidirectional instability with primarily a posterior component of instability; studies were excluded if their minimum follow-up was less than 1 year, if their patients had a history of habitual posterior shoulder instability, or if their patients had either bony procedures or thermal capsulorrhaphy. Data collected from each study included patient demographics, instability classifications (traumatic vs atraumatic), previous shoulder stabilizations, and clinical outcomes. After identifying and reviewing 283 abstracts, we found that 16 articles fulfilled the inclusion criteria--9 open studies (173 patients) and 7 arthroscopic trials (186 patients). The 2 treatment groups had similar sex distributions (P> .25). Mean age was 23 years for the open group and 26 years for the arthroscopic group (P< .02). Clinical outcomes were rated satisfactory by 72% of patients in the open group and 83% of patients in the arthroscopic group (P< .55), controlling for age. Eighty-five percent of patients treated with an open technique and 81% of patients treated arthroscopically returned to sports (P< .82). This study demonstrated no statistical difference in clinical outcomes for patients treated with either open or arthroscopic surgery for posterior shoulder instability.