Open versus arthroscopic surgical treatment for anterior shoulder dislocation : a comparative systematic review and meta-analysis over the past 20 years

Abstract

BACKGROUND : The purpose of this study was to perform a meta-analysis comparing open and arthroscopic surgery for the treatment of anterior shoulder instability by analyzing comparative studies during 2 different time intervals during the last 20 years. METHODS : We conducted a systematic review of MEDLINE, Embase, Scopus, and Google Scholar. Two groups were created by dividing studies according to the year of publication, those published from 1995 to 2004 or from 2005 to 2015. Publication bias and risk of bias were assessed using the Cochrane Collaboration's tools. Heterogeneity was assessed using the I2 statistics. RESULTS : A total of 22 studies (n = 1633) met the eligibility criteria. Comparison of the pooled estimate for all of these studies demonstrated no significant differences (P = .64) in clinical outcomes between open and arthroscopic shoulder stabilization. However, studies published from 1995 through 2004 demonstrated significant differences (P = .015) in recurrence rates favoring open surgery. In contrast, no significant differences (P = .09) in recurrence rates were observed for studies published from 2005 through 2015. The pooled estimate for all studies in both groups demonstrated significant differences (P = .001) in external rotation deficits between open and arthroscopic shoulder stabilization favoring arthroscopic surgery. CONCLUSION : Despite advances in surgical techniques and devices during the last 20 years, either open or arthroscopic surgical treatment of anterior shoulder dislocation results in similar clinical outcomes. The recurrence rate for arthroscopic surgical stabilization has only marginally decreased, from 16.8% to 14.2%. However, during the earlier decade from 1995 through 2004, patients treated with arthroscopic surgery had twice the risk of recurrence compared with an open procedure.