Arthroscopic stabilization of primary, recurrent anterior instability has become the procedure of choice with some infrequent exceptions. Failures of stabilization, both open and arthroscopic, can and do occur. Our experience with revision arthroscopic Bankart repair is detailed in this study.
This is a Level IV retrospective analysis of surgical intervention. 15 patients (12 men; 3 women) with a minimum 18 month follow up form the basis for this study. 21 patients underwent revision Bankart surgery, and 15 were available for follow up (71%). The average follow up was 22 months ranging from 18 to 70 months. The average age was 27, ranging from 17 to 44 years. 4 of the 15 were our arthroscopic failures while 10 were referred for treatment. 5 patients were felt to have significant bone loss and 4 were contact/collision athletes. Of the 15 failures, 11 were arthroscopic and 4 were following an open procedure.
At the time of surgery, 10 recurrent Bankart lesions were noted and 8 were felt to have a poorly tensioned capsule. Hardware was present in 6 cases, but the ability to place anchors was not significantly hampered. An average of 2.5 anchors were implanted. Of the 15 revisions, four failures were recorded (27% failure rate). Two patients sustained a recurrent dislocation following trauma while 2 experienced atraumatic subluxations. Two patients underwent further surgery to stabilize the shoulder. One of the five with significant bone loss experienced recurrent instability while one of the four contact athletes also sustained recurrent subluxation following revision surgery. Range of motion analysis revealed a 15-20 degree combined motion loss in the abducted, externally rotated position in those with significant bone loss.
Revision arthroscopic Bankart repair is a viable alternative to open revision surgery in cases of failed stabilization. The 27% failure rate in this revision group is consistent with results reported for open revision surgery. Although significant bone loss is considered a contraindication to a soft tissue repair, stability can be achieved with concomitant motion loss. The small number of patients in this study make exclusion criteria, such as contact sports, age, gender or bone loss, difficult to ascertain.
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