This expertise-based randomized trial compared open versus arthroscopic stabilization for recurrent traumatic anterior shoulder instability. 196 patients were randomized and followed for two years. The primary question was whether the two techniques differ in disease-specific quality of life (WOSI) and recurrence.
When counseling a patient with recurrent traumatic anterior instability, quality of life at two years is the same whether you go open or arthroscopic. The difference is recurrence. Open repair cut the recurrence rate roughly in half (11% vs 23%).
The decision framework the paper supports: identify the high-risk phenotype. A male patient, 25 or younger, with a radiographic Hill-Sachs lesion is the one most likely to fail. For this profile, favor open repair or plan for bony augmentation.
The expertise-based design is a strength. Each surgeon performed their preferred procedure, removing the bias of forcing surgeons to do operations they do not favor. This makes the recurrence finding more credible.
Appraise it carefully though. The recurrence difference sat exactly at p=0.05, and sensitivity analysis for missing patients could flip significance. The regression explained only 17% of recurrence, so activity level and bone loss (unquantified here) matter more than this model captures.
This expertise-based randomized trial compared open versus arthroscopic stabilization for recurrent traumatic anterior shoulder instability. 196 patients were randomized and followed for two years. The primary question was whether the two techniques differ in disease-specific quality of life (WOSI) and recurrence.
When counseling a patient with recurrent traumatic anterior instability, quality of life at two years is the same whether you go open or arthroscopic. The difference is recurrence. Open repair cut the recurrence rate roughly in half (11% vs 23%).
The decision framework the paper supports: identify the high-risk phenotype. A male patient, 25 or younger, with a radiographic Hill-Sachs lesion is the one most likely to fail. For this profile, favor open repair or plan for bony augmentation.
The expertise-based design is a strength. Each surgeon performed their preferred procedure, removing the bias of forcing surgeons to do operations they do not favor. This makes the recurrence finding more credible.
Appraise it carefully though. The recurrence difference sat exactly at p=0.05, and sensitivity analysis for missing patients could flip significance. The regression explained only 17% of recurrence, so activity level and bone loss (unquantified here) matter more than this model captures.