***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    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 Purpose The purpose of this study is to report long-term outcomes of the arthroscopic modified Caspari technique compared to an open capsular shift surgery to treat post-traumatic anterior shoulder recurrent instability . The hypothesis was that the open surgery group would show higher degenerative changes than to the modified Caspari technique group after a follow-up from 10 to 17 years . Methods One hundred and ten nonr and omized consecutive patients who underwent a surgical repair of recurrent unilateral anterior shoulder instability between 1990 and 1999 were retrospectively analyzed . Eighty-two patients were available for long-term follow-up . In particular , 49 patients ( 59.8 % ) ( group A ) were treated with arthroscopic transglenoid modified Caspari suturing technique ( mean follow-up 13.7 ± 2.2 years ) , whereas 33 patients ( 40.2 % ) ( group B ) were treated with combined open capsular shift and Bankart repair ( mean follow-up 15.7 ± 2.2 years ) . Patients were evaluated according to the failure rate ( re-dislocation ) , Rowe , UCLA , and Constant scores . Radiological osteoarthritis changes were ranked according to Samilson score . Results There were no statistically significant differences between the two groups concerning the failure rate ( n.s . ) , Rowe ( n.s . ) , UCLA ( n.s . ) , and Constant ( n.s . ) scores . Group A : re-dislocation rate 12.5 % ( 6 re-dislocations ) , Rowe 85.0 ± 22.6 , UCLA 26.4 ± 4.8 , and Constant 86.3 ± 16.7 . Group B : re-dislocation rate 9 % ( 3 re-dislocations ) , Rowe 83.2 ± 24.4 , UCLA 26.9 ± 4.2 , and Constant 87.4 ± 14.1 . Radiographic findings of osteoarthritis : 2 severe ( 4 % ) , 4 moderate ( 8 % ) , and 12 mild ( 25 % ) in group A ; 2 severe ( 6 % ) , 4 moderate ( 12 % ) , and 9 mild ( 27 % ) in group B ; differences between groups were not statistically significant ( n.s ) . Conclusions The results after both techniques were good in majority of patients , with no significant differences in terms of re-dislocation and osteoarthritis development . Compared to the current literature , the recurrence rate was high in both groups . The modified Caspari technique could be an arthroscopic alternative for older , non-athletic shoulders . Level of evidence Therapeutic Study —Retrospective Comparative Study , Level III Two hundred and forty-five patients who had had 247 primary anterior dislocations of the shoulder were followed for ten years in a multicenter study at twenty-seven Swedish hospitals . The ages of the patients at the time of the dislocation ranged from twelve to forty years . The patients were assigned to one of three treatment groups : immobilization with the arm tied with a b and age to the torso for three to four weeks after reduction of the dislocation ; use of a sling , which was discontinued after the patient was comfortable ; or immobilization for various duration s. At the ten-year follow-up evaluation , no additional dislocation had occurred in 129 shoulders ( 52 per cent ) . Recurrent dislocation necessitating operative treatment had developed in fifty-eight shoulders ( 23 per cent ) : thirty-four ( 34 per cent ) of the ninety-nine shoulders in patients who were twelve to twenty-two years old , sixteen ( 28 per cent ) of the fifty-seven shoulders in patients who were twenty-three to twenty-nine years old , and eight ( 9 per cent ) of the ninety-one shoulders in patients who were thirty to forty years old . Twenty-four ( 22 per cent ) of the shoulders that had had at least two recurrences during the first two or five years seemed to have stabilized spontaneously without operative intervention at ten years . Dislocation of the contralateral shoulder occurred in association with sixteen ( 16 per cent ) of the ninety-nine shoulders in patients who were twelve to twenty-two years old , twelve ( 21 per cent ) of the fifty-seven shoulders in patients who were twenty-three to twenty-nine years old , and only three ( 3 per cent ) of the ninety-one shoulders in patients who were thirty to forty years old . The type and duration of the initial treatment had no effect on the rate of recurrence .  Radiographs , made for 185 shoulders at the time of the primary dislocation , demonstrated an evident Hermodsson ( Hill-Sachs ) lesion in ninety-nine shoulders ( 54 per cent ) ; this finding was associated with a significantly worse prognosis with regard to recurrence than was no evident lesion ( p < 0.04 ) . Radiographs made for 208 shoulders at the ten-year follow-up examination were evaluated for post-dislocation arthropathy . Twenty-three shoulders ( 11 per cent ) had mild arthropathy and eighteen ( 9 per cent ) had moderate or severe arthropathy . Some of the shoulders that had arthropathy had had no recurrence Context : It remains unknown if arthroscopic repair of recurrent anterior shoulder instability is as effective as open repair . Objective : The purpose of this study is to analyze the literature to provide clinical recommendations regarding the most appropriate therapeutic intervention for recurrent anterior shoulder instability . Study Design : Systematic review of level I and II studies . Data Sources : PubMed , EMBASE , the Cochrane Data base of Systematic Review s , and secondary references from 1967 to March 2010 were appraised for studies that met the inclusion criteria . Study Selection : Inclusion criteria were English- language level I or level II trials involving the treatment of recurrent anterior shoulder instability . Exclusion criteria included non-English- language studies ; level III , IV , or V studies ; and trials examining treatment of first-time shoulder dislocation , posterior shoulder dislocation , or diagnoses other than recurrent anterior shoulder dislocations . Data Extraction : Included studies underwent quality appraisal independently by each author identifying strengths , weaknesses , and biases . Results : Four r and omized controlled trials compared the use of arthroscopic and open repair for recurrent anterior shoulder dislocations .  These studies show no statistically significant difference between the 2 operative approaches . No long-term follow-up data describing the effects of either surgical approach are available at this time . Each investigation had weaknesses in study design that decreased the validity of its findings . Conclusions : While limited , the available evidence from r and omized controlled trials does not show a statistically significant difference in redislocation rates , return to activity , and functional outcomes between the arthroscopic and open repair groups . Range of motion is marginally better following arthroscopic treatment when compared with open repair . Recommendations on the optimal surgical intervention can not be provided 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 groups . Two years ' follow-up evaluation included Constant and Rowe shoulder scores . Statistical analysis of data was performed using an unpaired t test ( significance for P < .05 ) . RESULTS No recurrence of dislocation of the involved shoulder has been reported in either group . Follow-up Constant and Rowe scores of the 2 groups were not significantly different . The only significant difference seen between the 2 groups was for range of motion evaluation with the Constant score . The mean value for group 1 ( 39.6 + /- 0.8 ) was significantly greater ( P = .017 ) than that for group 2 ( 37.8 + /- 2.0 ) . CONCLUSIONS 
    Output:
    
Comparison of the pooled estimate for all of these studies demonstrated no significant differences ( P = .64 ) in clinical outcomes between open and arthroscopic shoulder stabilization .
However , during the earlier decade from 1995 through 2004 , patients treated with arthroscopic surgery had twice the risk of recurrence compared with an open procedure