Results of revision after failed surgical treatment for traumatic anterior shoulder instability

Persistent anterior shoulder instability following surgical stabilization

“…Diagnostic errors encompass failure to recognize bony defects (present in up to 89% of primary surgery failures), posterior instability, multidirectional instability, or a humeral avulsion of the glenohumeral ligaments (HAGL; Lopiz- Morales et al, 2013;Mauro et al, 2011;Burkhart and De Beer, 2000; see Figure 13.1). Diagnostic errors encompass failure to recognize bony defects (present in up to 89% of primary surgery failures), posterior instability, multidirectional instability, or a humeral avulsion of the glenohumeral ligaments (HAGL; Lopiz- Morales et al, 2013;Mauro et al, 2011;Burkhart and De Beer, 2000; see Figure 13.1).…”

“…These include failure to adequately tension the capsule, nonanatomical repairs of the glenoid labrum, and incorrect placement of suture anchors (Lopiz-Morales et al, 2013;Kim et al, 2003;Cho et al, 2009;Creighton et al, 2007;Neri et al, 2007;Sisto, 2007;Meehan and Petersen, 2005). These include failure to adequately tension the capsule, nonanatomical repairs of the glenoid labrum, and incorrect placement of suture anchors (Lopiz-Morales et al, 2013;Kim et al, 2003;Cho et al, 2009;Creighton et al, 2007;Neri et al, 2007;Sisto, 2007;Meehan and Petersen, 2005).…”

“…While it has not yet been fully elucidated which Hill-Sachs lesions must be treated, Chen et al published an algorithm for humeral head defects suggesting that lesions less than 20% of humeral head could be treated with standard shoulder stabilization while defects with 20-30% may require tendon transfer or disimpaction with bone graft (Chen et al, 2005). Hill-Sachs defects that are 30-45% should be repaired with bone graft or humeral osteotomy whereas prosthetic reconstruction should be employed for defects greater than 45% (Lopiz-Morales et al, 2013;Chen et al, 2005). Hill-Sachs defects that are 30-45% should be repaired with bone graft or humeral osteotomy whereas prosthetic reconstruction should be employed for defects greater than 45% (Lopiz-Morales et al, 2013;Chen et al, 2005).…”

“…Unfortunately, the results of revision stabilization surgery, both open and arthroscopic, have been shown to be inferior to primary stabilization with highly variable failure rates that are directly proportional to the number of revisions performed (Lopiz-Morales et al, 2013;Meehan and Petersen, 2005;Marquardt et al, 2007). For instance, Levine et al found that persistent instability after one attempted revision was 17% compared to 44% in shoulders with multiple prior surgeries (Levine et al, 2000).…”

“…The Bankart procedure can be performed via both open and arthroscopic methods with a recurrence rate, as discussed below, of about 10% (Brophy and Marx, 2009). As reported by Lopiz-Morales et al (2013), nonanatomic bone block procedures have varying outcomes with reported recurrence rates of 20% with the Eden-Hybinette technique (Rahme et al, 2003), 15% with the Bristow-Latarjet technique (Schroder et al, 2006), and less than 5% with the Latarjet technique (Schroder et al, 2006). As reported by Lopiz-Morales et al (2013), nonanatomic bone block procedures have varying outcomes with reported recurrence rates of 20% with the Eden-Hybinette technique (Rahme et al, 2003), 15% with the Bristow-Latarjet technique (Schroder et al, 2006), and less than 5% with the Latarjet technique (Schroder et al, 2006).…”