Complications of Soft Tissue Repair Techniques for Shoulder Instability

  • Rupert MellerEmail author
  • Nael Hawi


Anterior shoulder dislocation is a common injury in patients between 16 and 60 years. Recurrent instability and deficits in shoulder function are results in up to 60% after nonoperative treatment [1]. The optimal surgical procedure is still on debate and depends on several parameters. Nonetheless, the results of open or arthroscopic procedures for shoulder stabilization are comparable, due to developments in special arthroscopic techniques [2]. A diagnostic challenge is to identify and to determinate significant bone loss of the glenoid and of the humerus. In cases with significant bony defects, the recurrence rate after arthroscopic soft tissue repair is known to be as high as 67% [2, 3].


  1. 1.
    Robinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am. 2006;88(11):2326–36.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Petrera M, Patella V, Patella S, Theodoropoulos J. A meta-analysis of open versus arthroscopic Bankart repair using suture anchors. Knee Surg Sports Traumatol Arthrosc. 2010;18(12):1742–7.CrossRefGoogle Scholar
  3. 3.
    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(7):677–94.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Jaggi A, Lambert S. Rehabilitation for shoulder instability. Br J Sports Med. 2010;44(5):333–40.CrossRefGoogle Scholar
  5. 5.
    von Eisenhart-Rothe R, Mayr HO, Hinterwimmer S, Graichen H. Simultaneous 3D assessment of glenohumeral shape, humeral head centering, and scapular positioning in atraumatic shoulder instability: a magnetic resonance-based in vivo analysis. Am J Sports Med. 2010;38(2):375–82.CrossRefGoogle Scholar
  6. 6.
    Moroder P, Ernstbrunner L, Pomwenger W, Oberhauser F, Hitzl W, Tauber M, Resch H, Moroder R. Anterior shoulder instability is associated with an underlying deficiency of the bony glenoid concavity. Arthroscopy. 2015;31(7):1223–31.CrossRefGoogle Scholar
  7. 7.
    Takwale VJ, Calvert P, Rattue H. Involuntary positional instability of the shoulder in adolescents and young adults. Is there any benefit from treatment? J Bone Joint Surg Br. 2000;82(5):719–23.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Moroder P, Minkus M, Bohm E, Danzinger V, Gerhardt C, Scheibel M. Use of shoulder pacemaker for treatment of functional shoulder instability: proof of concept. Obere Extrem. 2017;12(2):103–8.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Baker CL, Uribe JW, Whitman C. Arthroscopic evaluation of acute initial anterior shoulder dislocations. Am J Sports Med. 1990;18(1):25–8.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kralinger FS, Golser K, Wischatta R, Wambacher M, Sperner G. Predicting recurrence after primary anterior shoulder dislocation. Am J Sports Med. 2002;30(1):116–20.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Hovelius L, Olofsson A, Sandstrom B, Augustini BG, Krantz L, Fredin H, Tillander B, Skoglund U, Salomonsson B, Nowak J, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. a prospective twenty-five-year follow-up. J Bone Joint Surg Am. 2008;90(5):945–52.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am. 2000;82(1):35–46.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Shin SJ, Kim RG, Jeon YS, Kwon TH. Critical value of anterior glenoid bone loss that leads to recurrent glenohumeral instability after arthroscopic bankart repair. Am J Sports Med. 2017;45(9):1975–81.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Nakagawa S, Mae T, Sato S, Okimura S, Kuroda M. Risk factors for the postoperative recurrence of instability after arthroscopic bankart repair in athletes. Orthop J Sports Med. 2017;5(9):2325967117726494.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-sachs “remplissage”: an arthroscopic solution for the engaging hill-sachs lesion. Arthroscopy. 2008;24(6):723–6.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y, Okada K. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elbow Surg. 2007;16(5):649–56.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy. 2014;30(1):90–8.CrossRefGoogle Scholar
  18. 18.
    Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br. 2007;89(11):1470–7.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Phadnis J, Arnold C, Elmorsy A, Flannery M. Utility of the instability severity index score in predicting failure after arthroscopic anterior stabilization of the shoulder. Am J Sports Med. 2015;43(8):1983–8.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Frank RM, Saccomanno MF, McDonald LS, Moric M, Romeo AA, Provencher MT. Outcomes of arthroscopic anterior shoulder instability in the beach chair versus lateral decubitus position: a systematic review and meta-regression analysis. Arthroscopy. 2014;30(10):1349–65.CrossRefGoogle Scholar
  21. 21.
    DeFroda S, Bokshan S, Stern E, Sullivan K, Owens BD. Arthroscopic Bankart repair for the management of anterior shoulder instability: indications and outcomes. Curr Rev Musculoskelet Med. 2017;10(4):442–51.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Nho SJ, Frank RM, Van Thiel GS, Wang FC, Wang VM, Provencher MT, Verma NN. A biomechanical analysis of anterior Bankart repair using suture anchors. Am J Sports Med. 2010;38(7):1405–12.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ranawat AS, Golish SR, Miller MD, Caldwell PE 3rd, Singanamala N, Treme G, Costic R, Hart JM, Sekiya JK. Modes of failure of knotted and knotless suture anchors in an arthroscopic bankart repair model with the capsulolabral tissues intact. Am J Orthop (Belle Mead NJ). 2011;40(3):134–8.Google Scholar
  24. 24.
    Owens BDGE. Uncomplicated anterior instability: the “simple” arthroscopic Bankart reconstruction. In: Abrams JS, Bell RH, Tokish JM, editors. Advanced reconstruction: shoulder 2. Chicago, IL: AAOS; 2018.Google Scholar
  25. 25.
    Shibata H, Gotoh M, Mitsui Y, Kai Y, Nakamura H, Kanazawa T, Okawa T, Higuchi F, Shirahama M, Shiba N. Risk factors for shoulder re-dislocation after arthroscopic Bankart repair. J Orthop Surg Res. 2014;9:53.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    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(8):1755–63.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Diduch DR, Scanelli J, Tompkins M, Milewski MD, Carson E, Ma SY. Tissue anchor use in arthroscopic glenohumeral surgery. J Am Acad Orthop Surg. 2012;20(7):459–71.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    McCarty LP 3rd, Buss DD, Datta MW, Freehill MQ, Giveans MR. Complications observed following labral or rotator cuff repair with use of poly-L-lactic acid implants. J Bone Joint Surg Am. 2013;95(6):507–11.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Kim SH, Oh JH, Lee OS, Lee HR, Hargens AR. Postoperative imaging of bioabsorbable anchors in rotator cuff repair. Am J Sports Med. 2014;42(3):552–7.CrossRefGoogle Scholar
  30. 30.
    Barber FA, Dockery WD, Hrnack SA. Long-term degradation of a poly-lactide co-glycolide/beta-tricalcium phosphate biocomposite interference screw. Arthroscopy. 2011;27(5):637–43.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Milewski MD, Diduch DR, Hart JM, Tompkins M, Ma SY, Gaskin CM. Bone replacement of fast-absorbing biocomposite anchors in arthroscopic shoulder labral repairs. Am J Sports Med. 2012;40(6):1392–401.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Suchenski M, McCarthy MB, Chowaniec D, Hansen D, McKinnon W, Apostolakos J, Arciero R, Mazzocca AD. Material properties and composition of soft-tissue fixation. Arthroscopy. 2010;26(6):821–31.CrossRefGoogle Scholar
  33. 33.
    Tompane T, Carney J, Wu WW, Nguyen-Ta K, Dewing C, Provencher M, McDonald L, Gibson M, LeClere L. Glenoid bone reaction to all-soft suture anchors used for shoulder labral repairs. J Bone Joint Surg Am. 2018;100(14):1223–9.CrossRefGoogle Scholar
  34. 34.
    Owens BD, Harrast JJ, Hurwitz SR, Thompson TL, Wolf JM. Surgical trends in Bankart repair: an analysis of data from the American Board of Orthopaedic Surgery certification examination. Am J Sports Med. 2011;39(9):1865–9.CrossRefGoogle Scholar
  35. 35.
    Hawi N, Reinhold A, Suero EM, Liodakis E, Przyklenk S, Brandes J, Schmiedl A, Krettek C, Meller R. The anatomic basis for the arthroscopic Latarjet procedure: a cadaveric study. Am J Sports Med. 2016;44(2):497–503.CrossRefGoogle Scholar
  36. 36.
    Price MR, Tillett ED, Acland RD, Nettleton GS. Determining the relationship of the axillary nerve to the shoulder joint capsule from an arthroscopic perspective. J Bone Joint Surg Am. 2004;86-A(10):2135–42.CrossRefGoogle Scholar
  37. 37.
    Matsuki K, Sugaya H. Complications after arthroscopic labral repair for shoulder instability. Curr Rev Musculoskelet Med. 2015;8(1):53–8.CrossRefGoogle Scholar
  38. 38.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20(4):250–78. quiz 279–280.CrossRefGoogle Scholar
  39. 39.
    Ando A, Sugaya H, Takahashi N, Kawai N, Hagiwara Y, Itoi E. Arthroscopic management of selective loss of external rotation after surgical stabilization of traumatic anterior glenohumeral instability: arthroscopic restoration of anterior transverse sliding procedure. Arthroscopy. 2012;28(6):749–53.CrossRefGoogle Scholar
  40. 40.
    Shin JJ, Popchak AJ, Musahl V, Irrgang JJ, Lin A. Complications after arthroscopic shoulder surgery: a review of the American Board of Orthopaedic Surgery Database. J Am Acad Orthop Surg Glob Res Rev. 2018;2(12):e093.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Levine WN, Clark AM Jr, D’Alessandro DF, Yamaguchi K. Chondrolysis following arthroscopic thermal capsulorrhaphy to treat shoulder instability. A report of two cases. J Bone Joint Surg Am. 2005;87(3):616–21.CrossRefGoogle Scholar
  42. 42.
    Matsen FA 3rd, Papadonikolakis A. Published evidence demonstrating the causation of glenohumeral chondrolysis by postoperative infusion of local anesthetic via a pain pump. J Bone Joint Surg Am. 2013;95(12):1126–34.CrossRefGoogle Scholar
  43. 43.
    Harris JD, Gupta AK, Mall NA, Abrams GD, McCormick FM, Cole BJ, Bach BR Jr, Romeo AA, Verma NN. Long-term outcomes after Bankart shoulder stabilization. Arthroscopy. 2013;29(5):920–33.CrossRefGoogle Scholar
  44. 44.
    Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am. 1996;78(11):1677–84.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Franceschi F, Papalia R, Del Buono A, Vasta S, Maffulli N, Denaro V. Glenohumeral osteoarthritis after arthroscopic Bankart repair for anterior instability. Am J Sports Med. 2011;39(8):1653–9.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Trauma DepartmentHannover Medical School (MHH)HannoverGermany

Personalised recommendations