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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.

The abstracts were prepared by Cormac Kelly. Correspondence should be addressed to The Secretary, British Elbow and Shoulder Society, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE