Effect of open versus minimally invasive surgery on postoperative wound site complications in patients with recurrent shoulder instability: A meta-analysis

Abstract

The Latarjet procedure is the accepted method of operation for patients with anterior shoulder instability. However, as arthroscopy becomes more and more popular, more and more patients are being treated with minimally invasive techniques for the treatment of anteriorly unstable shoulder. This research aims to compare the curative effects of arthroscopic Latarjet (AL) and open Latarjet (OL) on postoperative anterior shoulder instability. Our hypothesis is that arthroscopy will produce better results than open surgery. During the study, a review was conducted on four main databases, including EMBASE and Cochrane Library. Six cohort studies comparing AL with OL in the treatment of anterior shoulder instability were included. Patients who were operated by open technique up to 2023 were referred to as OL and those who underwent arthroscopic surgery were referred to as AL. Comparison was made between the two methods of operation. The statistical analysis was done with RevMan 5.3. The analysis included Visual Analogue Scale (VAS) scores and postoperative wound infections. A total of six studies were included for analysis under inclusion and exclusion criteria. There were 798 patients, 476 was AL group and 322 was OL group. No statistical significance was found on the incidence of postoperative wound infection in the patients who underwent the Latarjet procedure (odds ratio [OR], 1.43; 95% confidence interval [CI], 0.28-7.31; p = 0.67) and the VAS score after surgery (mean difference [MD], 0.70; 95% CI, -0.67 to 2.06; p = 0.32) for patients. However, it has now been demonstrated that arthroscopy is a safe and viable alternative. The only drawback of arthroscopic Latarjet surgery is probably that it has a long learning curve and requires a lot of practice from the surgeon.

Keywords: VAS score; anterior shoulder instability (ASI); arthroscopic Latarjet (AL); open Latarjet (OL); wound infection.

FIGURE 1

Flow chart of the study.

FIGURE 2

Risk of bias diagram.

FIGURE 3

Summary of risk of bias.

FIGURE 4

Funnel plot of the results of intraoperative use of open surgery compared with arthroscopic surgery for postoperative wound infection in subjects undergoing surgery for anterior shoulder instability. OR, odds ratio.

FIGURE 5

Funnel plot of the results of postoperative wound Visual Analogue Scale (VAS) scores in subjects undergoing surgery for anterior shoulder instability using intraoperative open surgery compared with arthroscopic surgery. MD, mean difference.

FIGURE 6

Forest plot for the effect of intraoperative use of open surgery compared with arthroscopic surgery on postoperative wound infection in subjects undergoing surgery for anterior shoulder instability. CI, confidence interval.

FIGURE 7

Forest plot for the effects plot postoperative wound Visual Analogue Scale (VAS) scores in subjects undergoing surgery for anterior shoulder instability using intraoperative open surgery compared with arthroscopic surgery. CI, confidence interval.