Anterior instability of the shoulder has historically been treated with open surgical stabilization. Arthroscopic treatment for instability has become increasingly popular. With advances and understanding of the pathology and improved arthroscopic techniques and instrumentation, primary arthroscopic repair of anterior shoulder instability has proven successful. Nevertheless, failures following arthroscopic stabilization do occur. The purpose of this study is to evaluate the effectiveness of arthroscopic techniques for patients requiring revision anterior stabilization.
A retrospective review of 38 consecutive patients with failure of anterior shoulder stabilization was performed. Failure was defined by recurrent dislocations or subluxation following either an open or arthroscopic index surgical procedure. The only exclusion factor was the presence of extensive bone loss on the glenoid. All patients underwent arthroscopic revision stabilization procedures, which included extensive release of the labral ligamentous tissue and superior shift with an average of 4.2 suture anchors (3 to 6) with or without supplemental arthroscopic capsulorrhaphy. Rotator interval closure was also routinely performed. The patient then followed a standardized rehabilitation protocol.
Follow-up averaged 36 months (24 to 46 months). Return to previous activity level and rate of failure were evaluated as defined by motion, function, and any recurrent instability episodes. Of the 38 revision stabilizations evaluated, all had significant improvement in their post injury activity level using UCLA and Rowe scores (p<.05), but 3 of 38 patients developed recurrent instability after revision surgery for an overall success rate of 92%.
This study demonstrates that revision arthroscopic anterior stabilization using modern techniques can yield reliably successful outcomes.
© 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.