Arthroscopic Versus Open Stabilization for Traumatic Shoulder Instability

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00251264
Recruitment Status : Completed
First Posted : November 9, 2005
Last Update Posted : July 13, 2015
Calgary Regional Health Authority (CRHA)
Calgary Orthopaedic Research and Education Fund
Canadian Orthopaedic Foundation
Information provided by (Responsible Party):
Dr. Nicholas Mohtadi, University of Calgary

Brief Summary:

The purpose of this study is to compare arthroscopic and open shoulder stabilization procedures by measuring the disease-specific quality of life outcome in patients with traumatic unidirectional anterior instability of the shoulder at 2 and 5 years.

Hypothesis: There is no difference in disease-specific quality of life outcomes in patients with traumatic unidirectional anterior shoulder instability, undergoing an arthroscopic versus an open stabilization procedure.

Condition or disease Intervention/treatment Phase
Joint Instability Shoulder Dislocation Procedure: Open stabilization Procedure: Arthroscopic stabilization Not Applicable

Detailed Description:

Shoulder instability most commonly affects people in the late teens to mid thirties, which are the most active years, recreational and vocational. The resulting disability, time lost from work, as well as the effect on an individual's quality of life represent a significant clinical problem for the population and for the healthcare system.

The normal anatomy in the unstable shoulder can be restored using arthroscopic or open surgical stabilization techniques. There is considerable controversy surrounding the issue of arthroscopic versus open shoulder stabilization. Advocates of arthroscopic procedures cite the following as advantages: faster recovery, less post operative pain, decreased operative time, improved cosmetics, greater return of shoulder motion and the more accurate identification of intraarticular pathology. Those in favor of an open procedure cite superior long term results showing fewer recurrences with an open stabilization.

There are few published reports directly comparing arthroscopic versus open shoulder stabilization repairs. It is also difficult to compare the results of existing studies as they report on heterogeneous patient populations, using a variety of techniques on mixed pathologies, using different outcome scales and variable definitions of success and failure. This study will address this controversial issue by comparing the disease-specific quality of life outcomes in patients with traumatic unidirectional anterior shoulder instability undergoing an arthroscopic versus an open stabilization procedure.

This study is designed as a prospective randomized clinical trial with a second prospective analytical cohort study arm. In the randomized arm, patients are assigned to arthroscopic or open surgery based on varied block, computer-generated randomization. The expertise-based randomization method is used in this study, whereby the surgeons perform either arthroscopic or open surgery, but not both. Therefore, a patient is not only randomized to a treatment group, but is also assigned to the expert surgeon for that treatment.

Patients in the prospective analytical cohort study arm of the trial undergo shoulder stabilization (open or arthroscopic) with any surgeon and complete the same follow-up visits, however they have not been randomized. The outcomes of the prospective cohort will be compared to those of the randomized arm to determine if the expertise-based randomization method has an effect on patient outcome.

Disease-specific quality of life is assessed using the validated Western Ontario Shoulder Instability (WOSI) Index. The index has 21 questions divided into 4 categories: physical symptoms, sport/recreation/work, lifestyle and emotions. This self-administered questionnaire utilizes a 100mm visual analog scale format to provide an overall score out of 100. A lower score reflects a better quality of life.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 194 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Arthroscopic Versus Open Stabilization of Traumatic Unidirectional Anterior Shoulder Instability: A Randomized Clinical Trial
Study Start Date : November 2001
Actual Primary Completion Date : December 2010
Actual Study Completion Date : December 2013

Arm Intervention/treatment
Active Comparator: Open Procedure: Open stabilization
Following examination under anesthesia, a 5cm standard deltopectoral incision is made. Dissection is continued exploiting the deltopectoral internervous plane. The conjoined tendon is retracted medially. The underlying subscapularis tendon is identified and incised horizontally or split vertically in its midsubstance. If required for adequate exposure, the subscapularis split may be extended by incising the inferior component of the subscapularis tendon near its insertion on the lesser tuberosity. The shoulder is entered by performing a "T" shaped arthrotomy with retractors for full exposure of the glenoid. Shoulder pathology is addressed with suture anchor repair of any capsulolabral detachment (ie.Bankart lesion) and/ or a capsular plication for repair of capsular redundancy.
Other Names:
  • open shoulder stabilization
  • open Bankart reconstruction

Active Comparator: Arthroscopic Procedure: Arthroscopic stabilization
With the examination under anesthesia completed, the arthroscope is introduced through a standard posterior arthroscopy portal. A diagnostic arthroscopy is performed and the intraarticular pathology identified and documented. Any labral detachment (i.e. Bankart lesion) is repaired using suture anchor fixation and arthroscopic tying techniques. Capsular redundancy is addressed with the use of thermal electrocapsulorrhaphy or arthroscopic suture repair of the redundant capsule. With the repair complete, 40 cc of 0.5% Bupivicaine is introduced into the joint. A sterile dressing is applied over the wounds and the operated shoulder placed in a shoulder immobilizer.
Other Names:
  • Scope stabilization
  • Arthroscopic reconstruction

Primary Outcome Measures :
  1. Western Ontario Shoulder Instability (WOSI) Index [ Time Frame: Baseline, 3, 6, 12, 24 months post-operatively ]

Secondary Outcome Measures :
  1. American Shoulder and Elbow Society (ASES) score [ Time Frame: Baseline, 3, 6, 12, 24 months post-operatively ]
  2. Physical examination: range of motion, strength, stability [ Time Frame: Baseline, 3, 6, 12, 24 months post-operatively ]
  3. Return to sport or activity, return to work [ Time Frame: Baseline, 3, 6, 12, 24 months post-operatively ]
  4. Complications [ Time Frame: Intra-operatively and up to 2 weeks post-operatively ]
  5. Time to perform each procedure [ Time Frame: Day of surgery ]
  6. Economic cost of each procedure [ Time Frame: Day of surgery ]

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Ages Eligible for Study:   14 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Clinical:

    • Age 14 years or greater
    • Diagnosis of traumatic anterior shoulder instability, made by meeting all of the following:

      1. Radiographic evidence or documented physician assisted reduction of anterior shoulder dislocation following a traumatic injury.
      2. Ability to elicit unwanted glenohumeral translation which reproduce symptoms with one of the following tests: anterior apprehension, relocation test, or anterior load and shift test
  • Radiological:

    • Closed growth plate on a standardized series of x-rays consisting of a minimum of an anteroposterior view, lateral in the scapular plane and an axillary view.

Exclusion Criteria:

  • Clinical:

    • Diagnosis of multidirectional instability (MDI) or multidirectional laxity with anteroinferior instability (MDL-AII), made by two or more of:

      1. Symptomatic (pain or discomfort) in inferior or posterior direction
      2. Ability to elicit unwanted posterior glenohumeral translation that reproduces symptoms with posterior apprehension tests, or posterior load and shift test
      3. Positive sulcus sign of 1cm or greater that reproduces patient's clinical symptoms
    • Previous surgery on the affected shoulder other than diagnostic arthroscopy
    • Cases involving litigation
    • Significant tenderness of acromioclavicular/sternoclavicular joints on affected side
    • Confirmed connective tissue disorder (ie: Ehlers-Danlos, Marfan)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00251264

Canada, Alberta
University of Calgary Sport Medicine Centre
Calgary, Alberta, Canada, T2N 1N4
Sponsors and Collaborators
University of Calgary
Calgary Regional Health Authority (CRHA)
Calgary Orthopaedic Research and Education Fund
Canadian Orthopaedic Foundation
Principal Investigator: Nicholas Mohtadi, MD, FRCSC University of Calgary Sport Medicine Centre
Principal Investigator: Robert Hollinshead, MD, FRCSC University of Calgary Sport Medicine Centre

Publications of Results:
Other Publications:

Responsible Party: Dr. Nicholas Mohtadi, Clinical Professor and Orthopaedic Surgeon, University of Calgary Identifier: NCT00251264     History of Changes
Other Study ID Numbers: 15740
First Posted: November 9, 2005    Key Record Dates
Last Update Posted: July 13, 2015
Last Verified: July 2015

Keywords provided by Dr. Nicholas Mohtadi, University of Calgary:
Shoulder instability
Open stabilization
Bankart repair
Shoulder instability, traumatic
Anterior, unidirectional instability

Additional relevant MeSH terms:
Shoulder Dislocation
Joint Instability
Joint Dislocations
Bone Diseases
Musculoskeletal Diseases
Wounds and Injuries
Shoulder Injuries
Joint Diseases