Arthroscopic versus open acromioplasty: a meta-analysis.

BACKGROUND: To address persisting controversy in the literature concerning the efficacy of arthroscopic compared to open acromioplasty, a meta-analysis was performed to evaluate the treatment effect after both approaches. HYPOTHESIS: The final clinical outcomes will be the same after both open and arthroscopic acromioplasty. However, the arthroscopic technique results in faster recovery and less postoperative morbidity as reflected by faster return to work and decreased hospital stays. STUDY DESIGN: Meta-analysis; Level of evidence, 3. METHODS: We performed our search of published English language literature using PubMed. We also searched the proceedings from 4 major orthopaedic meetings convened from 2000 to 2007. Furthermore, the reference sections of all relevant articles were reviewed for pertinent studies and presentations. Nine studies met the inclusion criteria that directly compared arthroscopic versus open acromioplasty with minimum follow-up of 1 year. The analysis focused on 1-year clinical outcome and included comparison of the objective 100-point score, hospital stay, time until return to work, operative time, and complications. RESULTS: No significant differences were found in clinical outcomes or complications for the 2 groups. However, open acromioplasty was associated with longer hospital stays (2.3 days, P = .05) and a greater length in time until return to work (65.1 days) compared with the arthroscopic technique (48.6 days) (P < .05). CONCLUSION: Arthroscopic and open acromioplasty have equivalent ultimate clinical outcomes, operative times, and low complication rates. However, arthroscopic acromioplasty results in faster return to work and fewer hospital inpatient days compared with the open technique.

Suture anchor and percutaneous intra-articular transtendon biceps tenodesis.

Several arthroscopic biceps tenodesis techniques have been described for surgical management of tendonitis and/or partial thickness tears of the long head of the biceps brachii tendon resulting in recalcitrant anterior shoulder pain. This chapter describes an arthroscopic tenodesis using percutaneous intra-articular transtendon technique with suture anchor fixation. The percutaneous technique allows excellent access to the biceps tendon, and the addition of a suture anchor provides superior fixation to isolated soft tissue fixation.

Arthroscopic anterior shoulder instability repair: techniques, pearls, pitfalls, and complications.

Initial attempts to replicate the success of open anterior shoulder instability procedures using arthroscopic procedures were associated with unacceptably high failure rates. The resultant focus on identifying clear surgical indications and improving both arthroscopic technique and instrumentation has culminated in arthroscopic success rates approaching those of established open procedures. Current experience shows that with careful patient selection, strict adherence to proper surgical technique, and the avoidance of common surgical errors, excellent clinical results can be achieved with arthroscopic instability repair.