REVISION ARTHROSCOPIC SHOULDER STABILISATION FOR THE MANAGEMENT OF RECURRENT DISLOCATION FOLLOWING FAILED PRIMARY SURGICAL STABILISATION

Abstract

Aim: To characterise the reasons for failure following primary surgical stabilisation in a group of patients considered suitable to undergo revision surgical stabilisation using arthroscopic techniques.

Methods: Patients presenting to our institution following failure of a primary shoulder stabilisation who underwent a revision arthroscopic stabilisation were reviewed. Information about the index procedure, imaging and the findings at arthroscopy were used to characterise the mechanism of failure. Shoulders were assessed pre-op by clinical examination and the WOSI score. At the time of arthroscopy patients proceeded to an appropriate stabilisation procedure using either a suture anchor or a modified transglenoid technique. Shoulders underwent a standard rehabilitation protocol and were reviewed at 6 weeks and then 6 monthly.

Results: Twenty patients underwent a revision arthroscopic stabilisation and were included in the study. Index procedures were arthroscopic stabilisation 4, thermal shrinkage 10 (un-repaired Bankart in 6), open Bankart 2, Putti-Platt 2, unknown procedure 2. Time from index procedure to re-dislocation ranged from 3 months to 7 years. The mechanism of failure was due to soft-tissue problems in all cases and could be grouped into four different categories. Further trauma 4 Inappropriate primary procedure 7 Missed pathology 3 Technical error 6 At early follow up of 6 – 42 months following revision arthroscopic stabilisation 1 patient re-dislocated at 12 months due to further trauma.

Conclusion: Recurrent instability following surgical stabilisation maybe due to soft-tissue failure. Soft-tissue failure can be subdivided into further trauma, inappropriate primary procedure, missed pathology and technical error. Cases within these subdivisions may be suitable for revision surgery using arthroscopic techniques.