***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Sixty-two consecutive patients with recurrent traumatic anterior instability of the shoulder were prospect ively observed . Thirty patients were observed after arthroscopic stabilization  , and 32 were observed after open Bankart repair  during a mean follow-up of 36 and 40 months , respectively ( range , 24 to 60 months for both groups ) . To reattach the labrum , the arthroscopic technique used transglenoid sutures and the open technique used bone anchors . Redislocation occurred in two patients ( 6 % ) in the open repair group and in five patients ( 17 % ) in the arthroscopic repair group . Three of the five patients with redislocations in the arthroscopic repair group underwent reoperation . According to the criteria of Rowe et al. , 29 patients ( 90.6 % ) who had open repair and 24 patients ( 80 % ) who had arthroscopic repair had good-to-excellent results . The patients averaged 90.6 points in the open repair group and 83.1 points in the arthroscopic repair group postoperatively . Little or no limitations in their postoperative sports activities were reported by 30 patients ( 94 % ) who underwent open repair and by 25 patients ( 83 % ) who had arthroscopic repair . Despite similar patient population s and using arthroscopic examination to select the type of repair in both groups , the results of arthroscopic shoulder stabilization are inferior to those of the classic open Bankart procedure BACKGROUND The prevalence and risk factors for recurrent instability and functional impairment following a primary glenohumeral dislocation remain poorly defined in younger patients . We performed a prospect i ve cohort study to evaluate these outcomes . We also aim ed to produce guidelines for the design of future clinical trials , assessing the efficacy of interventions design ed to improve the outcome after a primary dislocation . METHODS We performed a prospect i ve cohort study of 252 patients ranging from fifteen to thirty-five years old who sustained an anterior glenohumeral dislocation and were treated with sling immobilization , followed by a physical therapy program . Patients received regular clinical follow-up to assess whether recurrent instability had developed . Functional assessment s were made and were compared for two subgroups : those who had not had instability develop and those who had received operative stabilization to treat recurrent instability . RESULTS On survival analysis , instability developed in 55.7 % of the shoulders within the first two years after the primary dislocation and increased to 66.8 % by the fifth year . The younger male patients were most at risk of instability , and 86.7 % of all of the patients known to have recurrent instability had this complication develop within the first two years . A small but measurable degree of functional impairment was present at two years after the initial dislocation in most patients . Sample -size calculations revealed that a relatively small number of patients with a primary dislocation would be required in future clinical trials examining the effects of interventions design ed to reduce the prevalence of recurrent instability and improve the functional outcome . CONCLUSIONS Recurrent instability and deficits of shoulder function are common after primary nonoperative treatment of an anterior shoulder dislocation . There is substantial variation in the risk of instability , with younger males having the highest risk and females having a much lower risk . Future clinical trials to evaluate primary interventions should evaluate the prevalence of recurrent instability and functional deficits , with use of an assessment tool specifically for shoulder instability , during the first two years after the initial dislocation BACKGROUND Anterior dislocation of the glenohumeral joint in younger patients is associated with a high risk of recurrence and persistent functional deficits . The aim of this study was to assess the efficacy of a primary arthroscopic Bankart repair , while controlling for the therapeutic effects produced by the arthroscopic intervention and joint lavage . METHODS In a single-center , double-blind clinical trial , eighty-eight adult patients under thirty-five years of age who had sustained a primary anterior glenohumeral dislocation were r and omized to receive either an arthroscopic examination and joint lavage alone or together with an anatomic repair of the Bankart lesion .  Assessment of the rate of recurrent instability , functional outcome ( with use of three scores ) , range of movement , patient satisfaction , direct health-service costs , and treatment complications was completed for eighty-four of these patients ( forty-two in each group ) during the subsequent two years . RESULTS In the two years after the primary dislocation , the risk of a further dislocation was reduced by 76 % and the risk of all recurrent instability was reduced by 82 % in the Bankart repair group compared with the group that had arthroscopy and lavage alone . The functional scores were also better ( p < 0.05 ) , the treatment costs were lower ( p = 0.012 ) , and patient satisfaction was higher ( p < 0.001 ) after arthroscopic repair . The improved functional outcome appeared to be mediated through the prevention of instability since the functional outcome in patients with stable shoulders was similar , irrespective of the initial treatment allocation . The patients who had a Bankart repair and played contact sports were also more likely to have returned to their sport at two years ( relative risk = 3.4 , p = 0.007 ) . CONCLUSIONS Following a first-time anterior dislocation of the shoulder , there is a marked treatment benefit from primary arthroscopic repair of a Bankart lesion , which is distinct from the so-called background therapeutic effect of the arthroscopic examination and lavage of the joint . However , primary repair does not appear to confer a functional benefit to patients with a stable shoulder at two years after the dislocation Background Nonoperative treatment of traumatic shoulder dislocations leads to a high rate of recurrent dislocations . Hypothesis Early arthroscopic treatment for shoulder dislocation will result in a lower recurrence rate than nonoperative treatment . Study Design Prospect i ve , r and omized clinical trial . Methods Two groups of patients were studied to compare nonoperative treatment with arthroscopic Bankart repair for acute , traumatic shoulder dislocations in young athletes . Fourteen nonoperatively treated patients underwent 4 weeks of immobilization followed by a supervised rehabilitation program . Ten operatively treated patients underwent arthroscopic Bankart repair with a bioabsorbable tack followed by the same rehabilitation protocol as the nonoperatively treated patients . The average follow-up was 36 months . Results Three patients were lost to follow-up . Twelve nonoperatively treated patients remained for follow-up . Nine of these ( 75 % ) developed recurrent instability . Six of the nine have required subsequent open Bankart repair for recurrent instability . Of the nine operatively treated patients available for follow-up , only one ( 11.1 % ) developed recurrent instability . Conclusions Arthroscopic stabilization of traumatic , first-time anterior shoulder dislocations is an effective and safe treatment that significantly reduces the recurrence rate of shoulder dislocations in young athletes when compared with conventional , nonoperative treatment PURPOSE The aim of this study was to evaluate , prospect ively , outcomes following arthroscopic Bankart repair performed with 2 types of suture anchor -- the G II ( DePuy Mitek , Raynham , MA ) nonabsorbable anchor and the Panalok ( DePuy Mitek ) absorbable anchor . METHODS Patients with a diagnosis of recurrent traumatic anterior instability of the shoulder who were seen in a single unit between April of 2000 and June of 2003 were considered for inclusion in the study . Patients were assessed preoperatively and postoperatively by means of a subjective , patient-related outcome measurement tool ( Oxford Instability Score ) , a visual analogue scale for pain and instability ( VAS Pain and VAS Instability ) , and a quality -of-life question naire ( Short Form-12 [ SF-12 ] ) . Length of follow-up was 1.5 to 5 years ( mean , 2.6 y ) . The incidence of recurrent instability and the level of sporting ability were recorded . Patients were r and omized to undergo surgical repair with nonabsorbable or absorbable anchors . RESULTS A total of 130 patients were included in this study , of whom 6 were lost to follow-up ; therefore 124 patients ( 95 % ) completed the study . Both types of anchor were highly effective . No differences in rate of recurrence or in any of the scores were noted between the 2 groups . In all , 4 patients in the nonabsorbable group and 3 in the absorbable group experienced additional episodes of dislocation after a traumatic event . Rate of redislocation in the whole series was therefore 6 % . In addition , 4 patients , all of them from the absorbable group ( 4 % ) , described ongoing symptoms of instability but no true dislocations . In all , 85 % of the patient group have returned to their previous level of sporting activity . CONCLUSIONS No differences in outcomes of arthroscopic Bankart repair were seen whether absorbable or nonabsorbable anchors were used . Both are highly effective , with a redislocation rate of 6 % . LEVEL OF EVIDENCE Level I , therapeutic r and omized controlled trial The purpose of this study was to compare patients with anterior shoulder instability who were treated with an open Bankart procedure with those treated with an arthroscopic procedure .  During a 3-year period , 43 patients ( 44 shoulders ) were surgically treated . Thirty-four patients were available for followup . Eighteen shoulders had open Bankart procedure , and 16 shoulders were treated arthroscopically . Capsular laxity can be better assessed with the open procedure . A Bankart lesion was found in all the patients in both series . Average followup for Group 1 was 34 months , and for Group 2 , it was 23 months . Group 1 had 83 % good to excellent results with no recurrent dislocation or reoperation . Group 2 had 50 % good to excellent results , and 50 % fair to poor results with 3 recurrent dislocations and 4 recurrent subluxations that required second operation . The average loss of external rotation in Group 1 was not significantly greater than that in Group 2 . Sixteen patients in Group 1 and 8 patients in Group 2 were able to return to their primary work or sport . Results of arthroscopic Bankart repair do not equal those of the open Bankart procedure for the rate of recurrence and postoperative range of motion . The followup reported is short , and more dislocations can be anticipated with longer followup Abstract A total of 41 consecutive patients ( 11 women and 30 men , median age 29 ( 18–51 ) years ) with unilateral , isolated , posttraumatic , recurrent anterior shoulder dislocation and a Bankart lesion were operatively repaired , either by an arthroscopic technique including a capsular plication , or by an open procedure with Mitec anchors . All the patients were followed prospect ively and evaluated after a median of 36 ( 30–52 ) months follow-up by a “ blind ” observer . Nineteen patients in each group had excellent or good results , and one in each group was grade d as fair . One patient in the arthroscopic group had a traumatic dislocation 5 months after the operation and was grade d as poor . Three patients experienced subluxations postoperatively , one in the arthroscopic and two in the open group . There was no significant difference in anterior-posterior shoulder laxity measured objective ly with Donjoy . The open Bankart repair group had a statistically significantly longer hospitalization ( P = 0.001 ) , a slight decrease in external range of motion , and more frequent cosmetic complaints . Apart from this , the results revealed no major differences between the two methods after a median of 36 months in this selected group of patients with longst and ing problems We performed a prospect i ve study of 117 patients ( 119 shoulders ) with symptomatic , recurrent anterior post-traumatic shoulder instability to compare open versus arthroscopic reconstruction . Arthroscopic reconstructions ( N = 66 ) were performed using bioabsorbable tacks ( Suretac fixators ) , whereas open reconstructions ( N = 53 ) were performed with suture anchors .  All of the patients had a Bankart lesion . Independent observers examined 108 of the 119 shoulders ( 91 % ) at a median follow-up period of 28 months ( range , 24 to 63 ) for the arthroscopic group and 36 months ( range , 24 to 63 ) for the open group . The recurrence rate , including both dislocations and subluxations , was 9 of 60 ( 15 % ) in the arthroscopic group , compared with 5 of 48 ( 10 % ) in the open group . At follow-up , the Rowe score was 93 points ( range , 39 to 100 ) and the Constant score was 91 points ( range , 56 to 100 ) in the arthroscopic group , compared with 89 points ( range , 53 to 100 and 57 to 100 for the Rowe and Constant scores , respectively ) for both scores in the open group . The only significant difference was in external rotation in abduction , which was 90 ° ( range , 50 ° to 135 ° ) in the arthroscopic group and 80 ° ( range , 25 ° to 115 ° ) in the open group . Both methods produced stable and well-functioning shoulders in the majority of patients PURPOSE The purpose of this study was to compare the results of arthroscopic and open repair of isolated Bankart lesions of the shoulder using metallic suture anchors . TYPE OF STUDY Prospect i ve r and omized clinical study . METHODS Sixty patients with traumatic anterior shoulder instability underwent a surgical repair of an isolated Bankart lesion . The patients were divided into 2 groups of 30 patients each . In group 1 , an arthroscopic repair was performed , and in group 2 , an open procedure was performed . The groups were homogeneous for gender , age , dominance , number of dislocations , time elapsed between first dislocation and surgery , and pathologic findings . In all cases of both groups , the lesion was repaired using metallic suture anchors carrying nonabsorbable braided sutures . Postoperative rehabilitation was the same for the 2 
    Output:
    
There were no differences in recurrence or complication rate among patients undergoing surgery after the primary dislocation when compared with those undergoing surgery after multiple recurrent episodes .
Clinical outcome measures significantly improved within all independent studies from preoperatively to postoperatively .