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Relative Indications for Open Surgery

Despite advancements in surgical technique and implants, certain clinical scenarios are prone to failure by arthroscopic methods. These include HAGL lesions and capsular ruptures. Other relative indications for open surgery include failed prior arthroscopic or open repairs. In the setting of failed thermal capsulorrhaphy, the surgeon is often faced with residual casulolabral tissue that is of poor quality or completely necrotic and absent that can only be addressed by open methods.

The treatment of the contact or high-demand athlete with anterior instability remains controversial. For some surgeons, shoulder instability in a contact athlete is a clear indication for open surgery, and excellent results have certainly been reported. Other skilled arthroscopists believe that with careful patient selection, arthroscopic approaches can yield similar results. Burkhart and DeBeer reported on a group of 194 patients who had undergone arthroscopic Bankart repair of the shoulder.

One hundred and one of these patients were contact athletes. Although the recurrence rate was 87% in those contact athletes who had significant bone defects, in those who did not have bone defects the recurrence rate was only 6.5%.

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