15-Year Data Comparing Arthroscopic to Open Shoulder Surgery

While the short-term results of both arthroscopic and open anterior shoulder stabilization have been well-studied, a comparison of long-term clinical outcomes has not been taken before, especially with the addition of an assessment of preoperative glenoid tracking.

In a new long-term study, “Arthroscopic Versus Open Anterior Shoulder Stabilization: A Prospective Randomized Clinical Trial With 15-Year Follow-up With An Assessment of the Glenoid Being ‘On-Track and ‘Off-Track” as a Predictor of Failure,” published online on June 8, 2021 in The American Journal of Sports Medicine, researchers found that both procedures offered similar long-term clinical outcomes for patients with recurrent anterior shoulder instability.

In addition to measuring the clinical outcomes of patients randomized to either arthroscopic or open anterior shoulder stabilization, the researchers conducted preoperative magnetic resonance imaging studies to assess whether the shoulders were “on-track” or “off-track” which could predict an increased failure risk.

Overall, 60 patients (28 arthroscopic and 32 open) were included in the study. The mean age of the patients at the time of the surgery was 25 years (ranger, 34-57 years).

They were followed for a minimum of 15 years after the surgery. The researchers defined clinical failure as any recurrent dislocation postoperative or subjective instability. The long-term failure rate for the arthroscopic patients was 14.3% (4 patients out of 28) and 12.5% (4 patients out of 32) for the open surgery patients.

The researchers found no significant differences in subjective shoulder outcome scores between the two treatment groups. And of the 56 shoulders for which MRI studies were available, 8 (14.3%) were reported to be off-track.

The glenoid track is defined as the area of contact between the humeral head and glenoid. If the lesion is larger than the glenoid track, it is determined to be “off-track” and at increased risk for instability.

Of the 8 shoulders designated as off-track, two were surgical failures, one in each treatment group. In the on-track group, 6 of the patients had failed surgery, 3 in each group (p = .280).

“Long-term clinical outcomes were comparable at 15 years postoperatively between the arthroscopic and open stabilization groups. The presence of an off-track lesion may be associated with a higher rate of recurrent instability in both cohorts at long-term follow-up; however, this study was underpowered to verify this situation,” the researchers wrote.