Arthroscopic, open shoulder stabilization may produce comparable long-term results

Research into on-track, off-track designations for shoulder stability might be helpful.

Patients with shoulder instability who underwent arthroscopic stabilization experienced clinical outcomes that were comparable to open stabilization surgery. Furthermore, there were no differences in the procedures’ subjective outcome scores at 15 years’ follow-up, according to study results.

“This prospective trial demonstrated the long-term efficacy of arthroscopic techniques when compared to previous gold standard open [techniques], and subjective scores declined in both groups with no significant differences,” Craig R. Bottoni, MD, said in a presentation of the study, which received the American Orthopaedic Society for Sports Medicine O’Donoghue Sports Injury Award. “In the long-term success, the vast majority of patients demonstrated that both techniques can provide excellent stability,” he said.

Bottoni told Orthopedics Today, “The results are consistent with what I thought was our ability to address the patho-anatomy of what we find when someone dislocates their shoulder, either a first time or [in] multiple episodes.”

Of 64 patients with recurrent anterior shoulder instability that investigators randomly assigned to undergo either arthroscopic or open stabilization in the initial prospective trial, Bottoni and colleagues assessed long-term clinical results for 60 patients. Investigators retrospectively assessed the preoperative MRIs using established techniques to calculate the on-track or off-track designation and compared the designation to their long-term clinical results.

Craig R. Bottoni, MD
Craig R. Bottoni

At a minimum of 15 years’ follow-up, 13% of patients experienced a failure, which was defined as any redislocation event or revision surgery performed for recurrent instability or subjective anterior instability.

“Both groups’ increased failure into the 15-year assessment was equally distributed between open and arthroscopic,” Bottoni said at the meeting.

Although subjective scores dropped in all categories, there was no difference in those scores for the two treatment groups at their latest follow-up. Both groups had similar Simple Shoulder Test and University of California Los Angeles scores through the 32-month and 15-year follow-up.

He told Orthopedics Today the concept of on-track and off-track did not seem to apply to this group of patients, with failed shoulders not consistently off-track and non-failed shoulders not consistently on-track. Based on MRI findings, shoulders were on-track in 48 patients and off-track in 8 patients.

The eight off-track shoulders were “almost equally distributed between arthroscopic and open” surgery, Bottoni said at the meeting.

In the interview with Orthopedics Today, Bottoni said he was not surprised by these findings because the arthroscopic techniques used matched closely to open techniques that were used at the time.

Although Bottoni said that it would take nearly 2 decades to repeat this study, he noted there may be other ways to research on-track and off-track designation, since the results of the study did not correlate well with the concepts of track designation.

“I think there are other studies that could look at longer-term clinical follow-up and then look back on [the patients’] MRIs and see if the on-track and off-track concept would be applicable,” Bottoni said. – by Casey Tingle

Disclosure: Bottoni reports he is a paid consultant and paid presenter or speaker for Arthrex; and receives research support from Arthrex and Musculoskeletal Transplant Foundation.

Patients with shoulder instability who underwent arthroscopic stabilization experienced clinical outcomes that were comparable to open stabilization surgery. Furthermore, there were no differences in the procedures’ subjective outcome scores at 15 years’ follow-up, according to study results.

“This prospective trial demonstrated the long-term efficacy of arthroscopic techniques when compared to previous gold standard open [techniques], and subjective scores declined in both groups with no significant differences,” Craig R. Bottoni, MD, said in a presentation of the study, which received the American Orthopaedic Society for Sports Medicine O’Donoghue Sports Injury Award. “In the long-term success, the vast majority of patients demonstrated that both techniques can provide excellent stability,” he said.

Bottoni told Orthopedics Today, “The results are consistent with what I thought was our ability to address the patho-anatomy of what we find when someone dislocates their shoulder, either a first time or [in] multiple episodes.”

Of 64 patients with recurrent anterior shoulder instability that investigators randomly assigned to undergo either arthroscopic or open stabilization in the initial prospective trial, Bottoni and colleagues assessed long-term clinical results for 60 patients. Investigators retrospectively assessed the preoperative MRIs using established techniques to calculate the on-track or off-track designation and compared the designation to their long-term clinical results.

Craig R. Bottoni, MD
Craig R. Bottoni

At a minimum of 15 years’ follow-up, 13% of patients experienced a failure, which was defined as any redislocation event or revision surgery performed for recurrent instability or subjective anterior instability.

“Both groups’ increased failure into the 15-year assessment was equally distributed between open and arthroscopic,” Bottoni said at the meeting.

Although subjective scores dropped in all categories, there was no difference in those scores for the two treatment groups at their latest follow-up. Both groups had similar Simple Shoulder Test and University of California Los Angeles scores through the 32-month and 15-year follow-up.

He told Orthopedics Today the concept of on-track and off-track did not seem to apply to this group of patients, with failed shoulders not consistently off-track and non-failed shoulders not consistently on-track. Based on MRI findings, shoulders were on-track in 48 patients and off-track in 8 patients.

The eight off-track shoulders were “almost equally distributed between arthroscopic and open” surgery, Bottoni said at the meeting.

In the interview with Orthopedics Today, Bottoni said he was not surprised by these findings because the arthroscopic techniques used matched closely to open techniques that were used at the time.

Although Bottoni said that it would take nearly 2 decades to repeat this study, he noted there may be other ways to research on-track and off-track designation, since the results of the study did not correlate well with the concepts of track designation.

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“I think there are other studies that could look at longer-term clinical follow-up and then look back on [the patients’] MRIs and see if the on-track and off-track concept would be applicable,” Bottoni said. – by Casey Tingle

Disclosure: Bottoni reports he is a paid consultant and paid presenter or speaker for Arthrex; and receives research support from Arthrex and Musculoskeletal Transplant Foundation.