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