Evaluation and treatment of failed shoulder instability procedures

Abstract

Management of the unstable shoulder after a failed stabilization procedure can be difficult and challenging. Detailed understanding of the native shoulder anatomy, including its static and dynamic restraints, is necessary for determining the patient’s primary pathology. In addition, evaluation of the patient’s history, physical exam, and imaging is important for identifying the cause for failure after the initial procedure. Common mistakes include under-appreciation of bony defects, failure to recognize capsular laxity, technical errors, and missed associated pathology. Many potential treatment options exist for revision surgery, including open or arthroscopic Bankart repair, bony augmentation procedures, and management of Hill Sachs defects. The aim of this narrative review is to discuss in-depth the common risk factors for post-surgical failure, components for appropriate evaluation, and the different surgical options available for revision stabilization.Level of evidence Level V.

How to handle minor and major bone loss in the shoulder? Current concepts

“…After a revision surgery, after failed primary shoulder dislocation, the reported failure rate does not exceed 20% of patients 46. The failure criteria are the same as after a primary surgery, that is, symptomatic shoulder instability, pain and shoulder stiffness.…”

“…A failure of the primary surgical stabilisation due to more extensive bony damage, either humeral, glenoid or both, is much more technically demanding for the revision surgery. Although <20% loss of GBL might not require bony procedure,46 loss of >30% of glenoid surface definitely should be treated by implantation of bone block structure, either by coracoid tip transfer with attached conjoint tendon that provide increase in glenoid bony surface, accompanied by the suspension by the conjoint tendon that increase dynamic stability to the head of humerus, (ie, Latarjet technique) or by autologous tricortical bone graft that also provide increased glenoid surface. If the initial failure mode was unsuccessful coracoid transfer due to its mal union or non-union, the implementation of the tricortical bone graft implantation (autologous) is logical to use as an alternative technique for treating glenoid deficiency with expected less favourable outcome expectations due to the high risk for postoperative stiffness after this type of procedure 47.…”

Safety and Effectiveness of Intra-articular Corticosteroid Injection Following Arthroscopic Shoulder Surgery

“…Adhesive shoulder arthritis, calci ed supraspinatus tendonitis, shoulder synovitis and shoulder osteoarthritis could cause irreversible shoulder joint damage with the main clinical manifestations of limited mobility and pain [1][2][3][4]. Although conservative treatment and open surgery have been the main treatment methods for these diseases, with the popularization of arthroscopy technology, it has become one of the main treatment option [5,6]. The main application advantages of shoulder arthroscopy are less injury of shoulder joint, su cient removal of focus, low postoperative pain and fast recovery [7].…”

Evaluation of the diagnostic performance of the simple method of computed tomography in the assessment of patients with shoulder instability: a prospective cohort study

“…Moreover, the management of the Bankart and bony Bankart lesions after a failed surgery could be challenging. Therefore, an adaptation of proper diagnostic modality is crucial in the detection of the Bankart and bony Bankart lesions [ 7 ]. The optimal treatment for the Bankart and bony Bankart lesions remains controversial [ 8 ].…”