Abstract
Aim: To characterise the reasons for failure following primary surgical stabilisation, the indications and the results of surgery in a subgroup of patients undergoing revision arthroscopic shoulder stabilisation.
Methods: All patients who underwent revision shoulder stabilisation over a 3 year period were included in the study. Information about the index procedure, imaging and the findings at arthroscopy were used to characterise the mechanism of failure. Patients were assessed clinically and WOSI scored at 6 and 12 months and then annually.
Results: Thirty-six patients were reviewed. Twenty underwent an arthroscopic (AR) and 15 underwent an open (OR) revision procedure. The AR index procedures were 15 arthroscopic (4 suture-anchor, 10 thermal shrinkage, 1 unknown) and 5 open (3 Bankart, 2 Putti-Platt). The OR index procedures were arthroscopic 10 (4 suture-anchor, 3 transglenoid, 2 thermal shrinkage) and 6 open (4 Bankart, 2 Putti-Platt). Soft-tissue failure was the primary mechanism in all AR cases (4 further trauma, 7 inappropriate primary procedure, 3 missed pathology, 6 technical error). The OR primary mechanism of failure was bone loss 12 (4 epileptic) and soft-tissue failure 3. At AR follow-up of 25.8 months (10–45) there had been 1 re-dislocation and 1 subluxation, mean WOSI 298 (68–517). There had been no OR re-dislocations at 22.5 months (10–42) follow-up, mean WOSI 313 (76–621).
Conclusion: Recurrent instability following surgical stabilisation maybe due to bone loss or soft-tissue failure (further trauma, inappropriate primary procedure, missed pathology, technical error). Revision arthroscopic surgery maybe indicated in soft tissue failure cases and can produce acceptable medium term results.
Correspondence should be addressed to Ms Larissa Welti, Scientific Secretary, EFORT Central Office, Technoparkstrasse 1, CH-8005 Zürich, Switzerland
