Risk Factors for Recurrent Shoulder Instability after Arthroscopic Revision Anterior Stabilization

Abstract

Introduction: Open revision stabilization is generally accepted as an effective option for recurrent anterior instability following a failed Bankart repair. However, to date, few large studies have examined the role of arthro-scopic revision anterior stabilization (ARAS) as a treatment option in these cases. The purpose of this study was to evaluate the outcomes of ARAS with a minimum of 2-years follow-up for patients with recurrent instability after failed index procedure. Methods: Sixty-five patients who underwent ARAS after failed index (open or arthroscopic) repair were included in this study. The mean age at the time of revision surgery was 26 years (range, 15-57 years). At an average follow-up of 4.7 years (range, 2 to 10.8 years), the rate of recurrent instability and risk factors for post-operative recurrence were evaluated. Glenoid and humeral bone loss were quantitatively assessed using pre-operative T1-weighted magnetic resonance arthrograms to determine if the lesions were on-or off-track. Results: Twenty-seven patients (42%) experienced recurrent anterior instability at a mean time of 2.3 years. The cause of revision failure was traumatic in 12 cases (44%). Age less than 22 years old, ligamentous laxity, the presence of an offtrack lesion, and a concomitant superior labral anterior to posterior (SLAP) tear were significantly associated with revision failure (p<0.05). On multivariate analysis, the presence of an off-track lesion, age less than 22 years, and ligamentous laxity were independent predictors of recurrence (p¼0.022, 0.028, and 0.031, respectively). Conclusion: Although ARAS remains a viable treatment for failed instability surgery, patient selection is of critical importance when considering an arthroscopic approach given overall high recurrence rates.