Systematic Review| Volume 30, ISSUE 3, P372-381, March 2014

Download started.


Recurrent Instability After Revision Anterior Shoulder Stabilization Surgery


      The purpose of this study was to perform a systematic review of the literature to compare outcomes of revision anterior stabilization surgeries based on technique. This study also sought to compare the impact of bone defects on outcomes.


      A systematic review of the electronic databases PubMed, Cochrane Central Register of Controlled Trials, and Scopus was performed in July 2012 and March 2013. Of 345 articles identified in the search, 17 studies with Level I to IV Evidence satisfied the inclusion criteria and were analyzed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Recurrent instability was defined as redislocation, resubluxation, or a positive apprehensive test after revision surgery. Procedures were categorized as arthroscopic Bankart repair, open Bankart repair, Bristow-Latarjet procedure, and other open procedures.


      In total, 388 shoulders were studied. Male patients comprised 74.1% of patients, 66.7% of cases involved the dominant shoulder, the mean age was 28.2 years, and the mean follow-up period was 44.2 months. The surgical procedures classified as “other open procedures” had the highest rate of recurrent instability (42.7%), followed by arthroscopic Bankart repair (14.7%), the Bristow-Latarjet procedure (14.3%), and open Bankart repair (5.5%). Inconsistent reporting of bone defects precluded drawing significant conclusions.


      A number of different procedures are used to address recurrent instability after a primary operation for anterior shoulder instability has failed. There is significant variability in the rate of recurrent instability after revision anterior shoulder stabilization surgery.

      Level of Evidence

      Level IV, systematic review of Level I to IV studies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dodson C.C.
        • Cordasco F.A.
        Anterior glenohumeral joint dislocations.
        Orthop Clin North Am. 2008; 39: 507-518
        • Cox C.L.
        • Kuhn J.E.
        Operative versus nonoperative treatment of acute shoulder dislocation in the athlete.
        Curr Sports Med Rep. 2008; 7: 263-268
        • Liu S.H.
        • Henry M.H.
        Anterior shoulder instability. Current review.
        Clin Orthop Relat Res. 1996; 323: 327-337
        • Kailes S.B.
        • Richmond J.C.
        Arthroscopic vs. open Bankart reconstruction: A comparison using expected value decision analysis.
        Knee Surg Sports Traumatol Arthrosc. 2001; 9: 379-385
        • Randelli P.
        • Ragone V.
        • Carminati S.
        • Cabitza P.
        Risk factors for recurrence after Bankart repair a systematic review.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 2129-2138
        • Ryu R.K.
        • Ryu J.H.
        Arthroscopic revision Bankart repair: A preliminary evaluation.
        Orthopedics. 2011; 34: 17
        • Thal R.
        • Nofziger M.
        • Bridges M.
        • Kim J.J.
        Arthroscopic Bankart repair using Knotless or BioKnotless suture anchors: 2- to 7-year results.
        Arthroscopy. 2007; 23: 367-375
        • Zaffagnini S.
        • Marcheggiani Muccioli G.M.
        • Giordano G.
        • et al.
        Long-term outcomes after repair of recurrent post-traumatic anterior shoulder instability: Comparison of arthroscopic transglenoid suture and open Bankart reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 816-821
        • Dewing C.B.
        • Horan M.P.
        • Millett P.J.
        Two-year outcomes of open shoulder anterior capsular reconstruction for instability from severe capsular deficiency.
        Arthroscopy. 2012; 28: 43-51
        • Shah A.S.
        • Karadsheh M.S.
        • Sekiya J.K.
        Failure of operative treatment for glenohumeral instability: Etiology and management.
        Arthroscopy. 2011; 27: 681-694
        • Skendzel J.G.
        • Sekiya J.K.
        Diagnosis and management of humeral head bone loss in shoulder instability.
        Am J Sports Med. 2012; 40: 2633-2644
        • Abouali J.A.
        • Hatzantoni K.
        • Holtby R.
        • Veillette C.
        • Theodoropoulos J.
        Revision arthroscopic Bankart repair.
        Arthroscopy. 2013; 29: 1572-1578
        • Fabbriciani C.
        • Milano G.
        • Demontis A.
        • Fadda S.
        • Ziranu F.
        • Mulas P.D.
        Arthroscopic versus open treatment of Bankart lesion of the shoulder: A prospective randomized study.
        Arthroscopy. 2004; 20: 456-462
        • Green M.R.
        • Christensen K.P.
        Arthroscopic versus open Bankart procedures: A comparison of early morbidity and complications.
        Arthroscopy. 1993; 9: 371-374
        • Millett P.J.
        • Clavert P.
        • Warner J.J.
        Open operative treatment for anterior shoulder instability: When and why?.
        J Bone Joint Surg Am. 2005; 87: 419-432
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.
        J Clin Epidemiol. 2009; 62: 1006-1012
      1. R Development Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: The R Foundation for Statistical Computing. Available from: Accessed February 25, 2013.

        • Alcid J.G.
        • Powell S.E.
        • Tibone J.E.
        Revision anterior capsular shoulder stabilization using hamstring tendon autograft and tibialis tendon allograft reinforcement: Minimum two-year follow-up.
        J Shoulder Elbow Surg. 2007; 16: 268-272
        • Arce G.
        • Arcuri F.
        • Ferro D.
        • Pereira E.
        Is selective arthroscopic revision beneficial for treating recurrent anterior shoulder instability?.
        Clin Orthop Relat Res. 2012; 470: 965-971
        • Barnes C.J.
        • Getelman M.H.
        • Snyder S.J.
        Results of arthroscopic revision anterior shoulder reconstruction.
        Am J Sports Med. 2009; 37: 715-719
        • Bartl C.
        • Schumann K.
        • Paul J.
        • Vogt S.
        • Imhoff A.B.
        Arthroscopic capsulolabral revision repair for recurrent anterior shoulder instability.
        Am J Sports Med. 2011; 39: 511-518
        • Boileau P.
        • Richou J.
        • Lisai A.
        • Chuinard C.
        • Bicknell R.T.
        The role of arthroscopy in revision of failed open anterior stabilization of the shoulder.
        Arthroscopy. 2009; 25: 1075-1084
        • Castagna A.
        • Garofalo R.
        • Melito G.
        • Markopoulos N.
        • De Giorgi S.
        The role of arthroscopy in the revision of failed Latarjet procedures.
        Musculoskelet Surg. 2010; 94: S47-S55
        • Cheung E.V.
        • Sperling J.W.
        • Hattrup S.J.
        • Cofield R.H.
        Long-term outcome of anterior stabilization of the shoulder.
        J Shoulder Elbow Surg. 2008; 17: 265-270
        • Cho N.S.
        • Yi J.W.
        • Lee B.G.
        • Rhee Y.G.
        Revision open Bankart surgery after arthroscopic repair for traumatic anterior shoulder instability.
        Am J Sports Med. 2009; 37: 2158-2164
        • Creighton R.A.
        • Romeo A.A.
        • Brown Jr., F.M.
        • Hayden J.K.
        • Verma N.N.
        Revision arthroscopic shoulder instability repair.
        Arthroscopy. 2007; 23: 703-709
        • Franceschi F.
        • Longo U.G.
        • 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
        • Iannotti J.P.
        • Antoniou J.
        • Williams G.R.
        • Ramsey M.L.
        Iliotibial band reconstruction for treatment of glenohumeral instability associated with irreparable capsular deficiency.
        J Shoulder Elbow Surg. 2002; 11: 618-623
        • Kim S.H.
        • Ha K.I.
        • Kim Y.M.
        Arthroscopic revision Bankart repair: A prospective outcome study.
        Arthroscopy. 2002; 18: 469-482
        • Lunn J.V.
        • Castellano-Rosa J.
        • Walch G.
        Recurrent anterior dislocation after the Latarjet procedure: Outcome after revision using a modified Eden-Hybinette operation.
        J Shoulder Elbow Surg. 2008; 17: 744-750
        • Neri B.R.
        • Tuckman D.V.
        • Bravman J.T.
        • Yim D.
        • Sahajpal D.T.
        • Rokito A.S.
        Arthroscopic revision of Bankart repair.
        J Shoulder Elbow Surg. 2007; 16: 419-424
        • Rowe C.R.
        • Zarins B.
        • Ciullo J.V.
        Recurrent anterior dislocation of the shoulder after surgical repair. Apparent causes of failure and treatment.
        J Bone Joint Surg Am. 1984; 66: 159-168
        • Schmid S.L.
        • Farshad M.
        • Catanzaro S.
        • Gerber C.
        The Latarjet procedure for the treatment of recurrence of anterior instability of the shoulder after operative repair: A retrospective case series of forty-nine consecutive patients.
        J Bone Joint Surg Am. 2012; 94: e751-e757
        • Sisto D.J.
        Revision of failed arthroscopic Bankart repairs.
        Am J Sports Med. 2007; 35: 537-541
        • Brophy R.H.
        • Marx R.G.
        The treatment of traumatic anterior instability of the shoulder: Nonoperative and surgical treatment.
        Arthroscopy. 2009; 25: 298-304
        • Burkhart S.S.
        • De Beer J.F.
        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
        • 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