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Volume 25, Issue 10 , Pages 1075-1084, October 2009

The Role of Arthroscopy in Revision of Failed Open Anterior Stabilization of the Shoulder

Pascal Boileau, M.D.
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, University of Nice, Nice, France
Julian Richou, M.D.
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, University of Nice, Nice, France
Andrea Lisai, M.D.
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, University of Nice, Nice, France
Christopher Chuinard, M.D., M.P.H.
- Great Lakes Orthopaedic Center, Traverse City, Michigan, U.S.A.
Ryan T. Bicknell, M.D., M.Sc., F.R.C.S.(C).
- Division of Orthopaedic Surgery, Department of Surgery, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
- Address correspondence and reprint requests to Ryan T. Bicknell, M.D., M.Sc., F.R.C.S.(C)., Division of Orthopaedic Surgery, Department of Surgery, Kingston General Hospital, Nickle 3, 76 Stuart St, Queen's University, Kingston, Ontario K7L 2V7, Canada

Received 24 October 2008; accepted 17 April 2009. published online 07 September 2009.

Purpose

The purpose of this study was to evaluate the results of revision arthroscopic stabilization after failed open anterior shoulder stabilization.

Methods

We studied a retrospective series of 22 consecutive patients with recurrent anterior shoulder instability after open surgical stabilization (12 Latarjet procedures, 4 Eden-Hybinette procedures, 3 open Bankart repairs, and 3 capsular shifts). Failure was associated with a traumatic episode in 12 patients, capsular laxity with persistent Bankart lesions in all patients, and a bone block complication in 13 patients. Labral reattachment and capsuloligamentous retensioning with suture anchors were performed in all cases. An additional rotator interval closure was performed in 4 cases and an inferior capsular application in 12. Bone block screws were removed during arthroscopy in 8 patients because of malpositioning or mobility. Nineteen patients were evaluated at a mean follow-up of 43 months.

Results

All patients returned to their previous occupations, including 6 cases of work-related injury. Of the patients, 1 (5%) had recurrent subluxation and 2 (11%) had persistent apprehension. The subjective shoulder value was 83% ± 23%. A good or excellent result was found in 85% of patients according to the Walch-Duplay score and 13 patients (67%) according to the Rowe score. Shoulder pain was found in 6 patients (32%) (4 with light pain and 2 with moderate pain). Of the 5 patients with osteoarthritis before surgery, 3 progressed by 1 stage.

Conclusions

Arthroscopic revision of failed open anterior shoulder stabilization provides satisfactory results in a selected patient population. Some persistent pain and osteoarthritis progression remain concerns. The main advantages of the arthroscopic approach are the avoidance of anterior dissection in front of the subscapularis, which places the axillary nerve at risk, and the ability to address the various soft-tissue pathologies encountered.