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Letter to the Editor |
1 Durham, North Carolina2 Minneapolis, Minnesota
Dear Editor:
We read with interest the recent article by Rhee et al titled "Anterior Shoulder Stabilization in Collision Athletes: Arthroscopic Versus Open Bankart Repair" (June 2006, pp 979–985). We believe that this study is important in showing that open Bankart repairs may have a higher probability of good results in a certain group of patients, but we feel the authors overstate their conclusions based on the results presented.
The authors found a 25% recurrent instability rate following arthroscopic surgery and 12.5% recurrence rate following open Bankart repair. Based on these findings, the authors conclude that open stabilization is a more reliable method of treating anterior shoulder instability in collision athletes. The authors do not discuss the relationship between the number of dislocations prior to surgical treatment and their treatment results. Prior to surgery, patients in the arthroscopic group averaged 17.6 dislocations and patients in the open group averaged 22.8 dislocations. With such high numbers of preoperative recurrent dislocations, the authors cannot support conclusions directed at all patients with anterior shoulder instability. Moreover, we believe that the large number of preoperative dislocations is a more important factor than collision sports participation when comparing results of arthroscopic and open Bankart repair.
Additionally, this was a retrospective study with twice as many patients in the open group as compared with the arthroscopic group. This type of study has tremendous potential for bias, both recognized and unrecognized. Only with a randomized clinical trial should the authors make the type of definitive conclusion presented in their article.
Despite these limitations, we do believe that this is an important study. Our experience also leads us to recommend open Bankart repair for patients with multiple recurrent anterior dislocations. However, based on the results presented, a better conclusion to this study would be that the findings suggest that open stabilization may lead to lower recurrence rates than arthroscopic stabilization in collision athletes with high numbers (greater than 17) of recurrent, traumatic anterior shoulder dislocations.
3 Seoul, Korea
Thank you for your sincere and valuable comments. We are pleased to offer our explanation to clarify the queries raised by you. The frequency of dislocation has been stated as one of the important factors in predicting postoperative redislocation. However, we feel that the cause of recurrence is multifactorial, with age of the patient at the time of first dislocation and the activity level of the patient being the most frequent as well as consistent parameters reported in the literature.1–7 In addition, despite having a higher frequency of dislocation (22.8 in the open repair group compared with 17.6 in the arthroscopic repair group), the open repair group showed a lower recurrence rate (12.5%) in our study. This strongly supports the conclusions we made in this study. We agree with you that a randomized controlled trial would be the ideal method to arrive at a definitive conclusion. However collision athletes are fewer in number as compared with other sports participants; therefore, to recruit a sufficient number of patients for such a study would be time-consuming and may pose some practical limitations in our center.
REFERENCES
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