Is Selective Arthroscopic Revision Beneficial for Treating Recurrent Anterior Shoulder Instability?
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Surgeons have traditionally treated recurrent shoulder dislocation by open methods. With the advent of arthroscopic repair techniques some surgeons reported higher recurrence rates than with open methods but some of those reports included patients with a variety of problems, including bone loss and those continuing in contact sports. It is unclear whether recurrence rates would be higher in patients without bone loss and those willing to forego contact sports.
We therefore determined recurrence rates and functional scores after arthroscopic revision shoulder stabilization in patients without bone loss and those not subsequently participating in contact sports.
Patients and Methods
We retrospectively reviewed 16 patients who underwent a revision arthroscopic Bankart repair using suture anchors. An arthroscopic approach was selected in patients with a unilateral traumatic injury and mild to moderate bone loss. Arthroscopic stabilization was contraindicated in patients with (1) multidirectional shoulder instability; (2) greater than 25% glenoid bone loss; (3) a Hill Sachs lesion involving more than one-third of the articular surface of the humeral head; and (4) patients electing to continue pursuing contact sports. At followup, physical examination of both shoulders was conducted. Several functional scores (Rowe, UCLA, and Constant & Murley) were compiled. The minimum followup was 24 months (mean, 31 months; range, 24–46 months).
The UCLA score (22–31), Constant & Murley score (69–80), and Rowe score (33–80) all improved. Shoulder instability recurred in three of the 16 patients, two sustaining dislocations and one a subluxation. One recurrence was the result of new trauma and this patient underwent an open Latarjet procedure; the other two patients refused further surgery.
Revision arthroscopic Bankart repair using suture anchors was associated with a low recurrence rate and restoration of acceptable function in patients without bone loss and not participating in contact sports.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Barnes CJ, Getelman MH, Snyder SJ. Results of arthroscopic revision anterior shoulder reconstruction. Am J Sports Med. 2009;37:715–719. CrossRef
- Boileau P, Richou J, Lisai A, Chuinard C, Bicknell RT. The role of arthroscopy in revision of failed open anterior stabilization of the shoulder. Arthroscopy. 2009;25:1075–1084. CrossRef
- Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am. 2006;88:1755–1763. CrossRef
- Bottoni CR, Smith EL, Berkowitz MJ, Towle RB, Moore JH. Arthroscopic versus open shoulder stabilization for recurrent anterior instability: a prospective randomized clinical trial. Am J Sports Med. 2006;34:1730–1737. CrossRef
- Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16:677–694. CrossRef
- Bz NS, Hwang JC, Rhee YG. Arthroscopic stabilization in anterior shoulder instability: collision athletes versus noncollision athletes. Arthroscopy. 2006;22:947–953. CrossRef
- Bz NS, Yi JW, Lee BG, Rhee YG. Revision open Bankart surgery after arthroscopic repair for traumatic anterior shoulder instability. Am J Sports Med. 2009;37:2158–2164. CrossRef
- Cole BJ, L’Insalata J, Irrgang J, Warner JJ. Comparison of arthroscopic and open anterior shoulder stabilization. A two to six-year follow-up study. J Bone Joint Surg Am. 2000;82:1108–1114. CrossRef
- Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.
- Creighton RA, Romeo AA, Brown FM Jr, Hayden JK, Verma NN. Revision arthroscopic shoulder instability repair. Arthroscopy. 2007;23:703–709. CrossRef
- Edouard P, Beguin L, Fayolle-Minon I, Degache F, Farizon F, Calmels P. Relationship between strength and functional indexes (Rowe and Walch-Duplay scores) after shoulder surgical stabilization by the Latarjet technique. Ann Phys Rehabil Med. 2010;53:499–510. CrossRef
- Fabbriciani C, Milano G, Demontis A, Fadda S, Ziranu F, Mulas PD. Arthroscopic versus open treatment of Bankart lesion of the shoulder: a prospective randomized study. Arthroscopy. 2004;20:456–462. CrossRef
- Fehringer EV, Buck DC, Puumala SE, Clare DJ, Clare PE. Open anterior repair without routine capsulorraphy for traumatic anterior shoulder instability in a community setting. Orthopedics. 2008;31:365. CrossRef
- Franceschi F, Longo UG, Ruzzini L, Rizzello G, Maffulli N, Denaro V. Arthroscopic salvage of failed arthroscopic Bankart repair: a prospective study with a minimum follow-up of 4 years. Am J Sports Med. 2008;36:1330–1336. CrossRef
- Freedman KB, Smith AP, Romeo AA, Cole BJ, Bach BR Jr. Open Bankart repair versus arthroscopic repair with transglenoid sutures or bioabsorbable tacks for recurrent anterior instability of the shoulder: a meta-analysis. Am J Sports Med. 2004;32:1520–1527. CrossRef
- Garofalo R, Mocci A, Moretti B, Callari E, Di Giacomo G, Theumann N, Cikes A, Mouhsine E. Arthroscopic treatment of anterior shoulder instability using knotless suture anchors. Arthroscopy. 2005;21:1283–1289. CrossRef
- Kim SH, Ha KI. Bankart repair in traumatic anterior shoulder instability: open versus arthroscopic technique. Arthroscopy. 2002;18:755–763. CrossRef
- Kim SH, Ha KI, Cho YB, Ryu BD, Oh I. Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up. J Bone Joint Surg Am. 2003;85:1511–1518. CrossRef
- Kirkley A, Griffin S, Dainty K. Scoring systems for the functional assessment of the shoulder. Arthroscopy. 2003;19:1109–1120. CrossRef
- Krueger D, Kraus N, Pauly S, Chen J, Scheibel M. Subjective and objective outcome after revision arthroscopic stabilization for recurrent anterior instability versus initial shoulder stabilization. Am J Sports Med. 2011;39:71–77. CrossRef
- Lai D, Ma HL, Hung SC, Chen TH, Wu JJ. Open Bankart repair with suture anchors for traumatic recurrent anterior shoulder instability: comparison of results between small and large Bankart lesions. Knee Surg Sports Traumatol Arthrosc. 2006;14:82–87. CrossRef
- Levine WN, Arroyo JS, Pollock RG, Flatow EL, Bigliani LU. Open revision stabilization surgery for recurrent anterior glenohumeral instability. Am J Sports Med. 2000;28:156–160.
- Mazzocca AD, Brown FM Jr, Carreira DS, Hayden J, Romeo AA. Arthroscopic anterior shoulder stabilization of collision and contact athletes. Am J Sports Med. 2005;33:52–60. CrossRef
- Meehan RE, Petersen SA. Results and factors affecting outcome of revision surgery for shoulder instability. J Shoulder Elbow Surg. 2005;14:31–37. CrossRef
- Millar NL, Murrell GA. The effectiveness of arthroscopic stabilisation for failed open shoulder instability surgery. J Bone Joint Surg Br. 2008;90:745–750. CrossRef
- Neri BR, Tuckman DV, Bravman JT, Yim D, Sahajpal DT, Rokito AS. Arthroscopic revision of Bankart repair. J Shoulder Elbow Surg. 2007;16:419–424. CrossRef
- Patel RV, Apostle K, Leith JM, Regan WD. Revision arthroscopic capsulolabral reconstruction for recurrent instability of the shoulder. J Bone Joint Surg Br. 2008;90:1462–1467. CrossRef
- Rowe CR, Zarins B, Ciullo JV. Recurrent anterior dislocation of the shoulder after surgical repair. Apparent causes of failure and treatment. J Bone Joint Surg Am. 1984;66:159–168.
- Sugaya H, Moriishi J, Kanisawa I, Tsuchiya A. Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. J Bone Joint Surg Am. 2005;87:1752–1760. CrossRef
- Sugaya H, Moriishi J, Kanisawa I, Tsuchiya A. Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. Surgical technique. J Bone Joint Surg Am. 2006;88(Suppl 1):159–169. CrossRef
- Tauber M, Resch H, Forstner R, Raffl M, Schauer J. Reasons for failure after surgical repair of anterior shoulder instability. J Shoulder Elbow Surg. 2004;13:279–285. CrossRef
- Terry GC, Friedman SJ, Uhl TL. Arthroscopically treated tears of the glenoid labrum. Factors influencing outcome. Am J Sports Med. 1994;22:504–512. CrossRef
- Zabinski SJ, Callaway GH, Cohen S, Warren RF. Revision shoulder stabilization: 2- to 10-year results. J Shoulder Elbow Surg. 1999;8:58–65. CrossRef
- Is Selective Arthroscopic Revision Beneficial for Treating Recurrent Anterior Shoulder Instability?
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