Overview of Shoulder Approaches: Choosing Between Mini-incision and Arthroscopic Techniques

  • Raymond A. Klug
  • Bradford O. Parsons
  • Evan L. FlatowEmail author


In recent years, there has been great interest in minimally invasive orthopedic surgery. Several branches of orthopedics have embraced the principles of minimally invasive surgery, including traumatology,1–3 spinal surgery,4 and adult reconstruction.5–7 By far the greatest influence has been felt in the field of sports medicine with the introduction, routine, and later obligate use of the arthroscope. Indeed, the days of the open menisectomy or extraarticular anterior cruciate ligament (ACL) reconstruction are almost beyond us, as in these and many other cases, arthroscopic and arthroscopically assisted techniques have become the standard of care. More recently, the field of shoulder and elbow surgery has begun a similar transition; however, a single, distinct difference exists. Previously in sports medicine, the arthroscope was a new tool and standard open procedures were subsequently approached arthroscopically; however, we are currently witnessing a surge of interest in minimally invasive approaches to techniques that are not amenable to arthroscopic treatment, such as arthroplasty5–7 or plate osteosynthesis for fractures.1–3 This creates an interesting dilemma: when to choose arthroscopy versus minimally invasive open surgery or even more traditional open approaches.


  1. 1.
    Janzing, H. M., Houben, B. J., Brandt, S. E., Chhoeurn, V., Lefever, S., Broos, P., Reynders, P., and Vanderschot, P. The Gotfried Percutaneous Compression Plate versus the Dynamic Hip Screw in the treatment of pertrochanteric hip fractures: minimal invasive treatment reduces operative time and postoperative pain. J Trauma, 2002 52(2): 293–8CrossRefPubMedGoogle Scholar
  2. 2.
    Perren, S. M. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br, 2002 84(8): 1093–110CrossRefPubMedGoogle Scholar
  3. 3.
    Schutz, M., Muller, M., Krettek, C., Hontzsch, D., Regazzoni, P., Ganz, R., and Haas, N. Minimally invasive fracture stabilization of distal femoral fractures with the LISS: a prospective multicenter study. Results of a clinical study with special emphasis on difficult cases. Injury, 2001 32(Suppl 3): SC48–54PubMedGoogle Scholar
  4. 4.
    Olinger, A., Hildebrandt, U., Mutschler, W., and Menger, M. D. First clinical experience with an endoscopic retroperitoneal approach for anterior fusion of lumbar spine fractures from levels T12 to L5. Surg Endosc, 1999 13(12): 1215–9CrossRefPubMedGoogle Scholar
  5. 5.
    Berger, R. A., Deirmengian, C. A., Della Valle, C. J., Paprosky, W. G., Jacobs, J. J., and Rosenberg, A. G. A technique for minimally invasive, quadriceps-sparing total knee arthroplasty. J Knee Surg, 2006 19(1): 63–70PubMedGoogle Scholar
  6. 6.
    Berger, R. A., Jacobs, J. J., Meneghini, R. M., Della Valle, C., Paprosky, W., and Rosenberg, A. G. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res, 2004 (429): 239–47CrossRefGoogle Scholar
  7. 7.
    Goldstein, W. M., Branson, J. J., Berland, K. A., and Gordon, A. C. Minimal-incision total hip arthroplasty. J Bone Joint Surg Am, 2003 85-A(Suppl 4): 33–8PubMedGoogle Scholar
  8. 8.
    Blaine, T., Voloshin, I., Setter, K., and Bigliani, L. U. Minimally invasive approach to shoulder arthroplasty. In: Scuderi, G. R., Tria, A. J. Jr., and Berger, R. A., (Eds.) MIS Techniques in Orthopaedics. New York, NY, Springer, 2006, pp. 45–70CrossRefGoogle Scholar
  9. 9.
    Hsu, J., and Galatz, L. M. Mini-incision fixation of proximal humeral four-part fractures. In: Scuderi, G. R., Tria, A. J. Jr., and Berger, R. A., (Eds.) MIS Techniques in Orthopaedics. New York, NY, Springer, 2006, pp. 32–44CrossRefGoogle Scholar
  10. 10.
    Rhee, Y. G., Ha, J. H., and Cho, N. S. Anterior shoulder stabilization in collision athletes: arthroscopic versus open Bankart repair. Am J Sports Med, 2006 34(6): 979–85CrossRefPubMedGoogle Scholar
  11. 11.
    Romeo, A. A., Arciero, R. A., and Conner, P. M. Management of the in-season collision athlete with shoulder instability. In: Burks, R. T. (Ed.) American Shoulder and Elbow Surgeons/American Orthopaedic Society for Sports Medicine Specialty Day Joint Session. Proceedings of the 72nd Annual Meeting of the American Academy of Orthopaedic Surgeons, Chicago, IL, 2006Google Scholar
  12. 12.
    Abrams, J. S., and Savoie, F. H. III. Arthroscopic rotator cuff repair: is it the new gold standard? In: 72nd Annual Meeting of the American Academy of Orthopaedic Surgeons. Washington, DC, 2005, pp. 71Google Scholar
  13. 13.
    Yamaguchi, K., Ball, C. M., and Galatz, L. M. Arthroscopic rotator cuff repair: transition from mini-open to all-arthroscopic. Clin Orthop Relat Res, 2001 (390): 83–94Google Scholar
  14. 14.
    Yamaguchi, K., Levine, W. N., Marra, G., Galatz, L. M., Klepps, S., and Flatow, E. L. Transitioning to arthroscopic rotator cuff repair: the pros and cons. Instr Course Lect, 2003 52: 81–92PubMedGoogle Scholar
  15. 15.
    Buess, E., Steuber, K. U., and Waibl, B. Open versus arthroscopic rotator cuff repair: a comparative view of 96 cases. Arthroscopy, 2005 21(5): 597–604CrossRefPubMedGoogle Scholar
  16. 16.
    Sauerbrey, A. M., Getz, C. L., Piancastelli, M., Iannotti, J. P., Ramsey, M. L., and Williams, G. R., Jr. Arthroscopic versus mini-open rotator cuff repair: a comparison of clinical outcome. Arthroscopy, 2005 21(12): 1415–20CrossRefPubMedGoogle Scholar
  17. 17.
    Severud, E. L., Ruotolo, C., Abbott, D. D., and Nottage, W. M. All-arthroscopic versus mini-open rotator cuff repair: a long-term retrospective outcome comparison. Arthroscopy, 2003 19(3): 234–8CrossRefPubMedGoogle Scholar
  18. 18.
    Verma, N. N., Dunn, W., Adler, R. S., Cordasco, F. A., Allen, A., MacGillivray, J., Craig, E., Warren, R. F., and Altchek, D. W. All-arthroscopic versus mini-open rotator cuff repair: a retrospective review with minimum 2-year follow-up. Arthroscopy, 2006 22(6): 587–94CrossRefPubMedGoogle Scholar
  19. 19.
    Warner, J. J., Tetreault, P., Lehtinen, J., and Zurakowski, D. Arthroscopic versus mini-open rotator cuff repair: a cohort comparison study. Arthroscopy, 2005 21(3): 328–32CrossRefPubMedGoogle Scholar
  20. 20.
    Youm, T., Murray, D. H., Kubiak, E. N., Rokito, A. S., and Zuckerman, J. D. Arthroscopic versus mini-open rotator cuff repair: a comparison of clinical outcomes and patient satisfaction. J Shoulder Elbow Surg, 2005 14(5): 455–9CrossRefPubMedGoogle Scholar
  21. 21.
    Baker, C. L., Whaley, A. L., and Baker, M. Arthroscopic rotator cuff tear repair. J Surg Orthop Adv, 2003 12(4): 175–90PubMedGoogle Scholar
  22. 22.
    Norberg, F. B., Field, L. D., and Savoie, F. H., III. Repair of the rotator cuff. Mini-open and arthroscopic repairs. Clin Sports Med, 2000 19(1): 77–99CrossRefPubMedGoogle Scholar
  23. 23.
    Caprise, P. A., Jr. and Sekiya, J. K. Open and arthroscopic treatment of multidirectional instability of the shoulder. Arthroscopy, 2006 22(10): 1126–31CrossRefPubMedGoogle Scholar
  24. 24.
    Levine, W. N., Rieger, K., and McCluskey, G. M., III. Arthroscopic treatment of anterior shoulder instability. Instr Course Lect, 2005 54: 87–96PubMedGoogle Scholar
  25. 25.
    Mohtadi, N. G., Bitar, I. J., Sasyniuk, T. M., Hollinshead, R. M., and Harper, W. P. Arthroscopic versus open repair for traumatic anterior shoulder instability: a meta-analysis. Arthroscopy, 2005 21(6): 652–8CrossRefPubMedGoogle Scholar
  26. 26.
    Cole, B. J., Millett, P. J., Romeo, A. A., Burkhart, S. S., Andrews, J. R., Dugas, J. R., and Warner, J. J. Arthroscopic treatment of anterior glenohumeral instability: indications and techniques. Instr Course Lect, 2004 53: 545–58PubMedGoogle Scholar
  27. 27.
    Millett, P. J., Clavert, P., and Warner, J. J. Open operative treatment for anterior shoulder instability: when and why? J Bone Joint Surg Am, 2005 87(2): 419–32CrossRefPubMedGoogle Scholar
  28. 28.
    Salvi, A. E., Paladini, P., Campi, F., and Porcellini, G. The Bristow-Latarjet method in the treatment of shoulder instability that cannot be resolved by arthroscopy. A review of the literature and technical-surgical aspects. Chir Organi Mov, 2005 90(4): 353–64PubMedGoogle Scholar
  29. 29.
    Bottoni, P. C., Smith, E. L., Berkowitz, M. J., Towle, R. B., and Moore, J. H. Arthroscopic versus open shoulder stabilization for recurrent anterior instability: a prospective randomized clinical trial. Am J Sports Med, 2006 34(11): 1730–7CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Raymond A. Klug
    • 1
  • Bradford O. Parsons
    • 1
  • Evan L. Flatow
    • 1
    Email author
  1. 1.Peter & Leni May Department of Orthopaedic SurgeryMount Sinai Medical CenterNew YorkUSA

Personalised recommendations