Revision arthroscopic shoulder instability repair.
OBJECTIVE
The purpose of this study was to report on a difficult patient population and to critically evaluate the role of revision arthroscopic stabilization surgery.


METHODS
Eighteen patients with failed traumatic instability repairs were treated with revision arthroscopic labral fixation and plication with a mean follow-up of 29.7 months (range, 24 to 48 months). There were 15 male patients and 3 female patients with a mean age of 28.6 years (range, 15 to 50 years). Of the 18 patients, 9 were Workers' Compensation cases. The 18 patients had a mean of 1.55 surgeries before our revision surgery, with 9 having a component of thermocapsular shrinkage. The patients' characteristics, operative techniques, and findings were recorded, and their clinical outcome was critically evaluated (via physical examination, visual analog pain scale, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, and Short Form 12).


RESULTS
The revision surgery incorporated a 4-portal technique via a mean of 4.6 suture anchors and 3 plication stitches, and 15 patients received a rotator interval closure. At the follow-up evaluation, 13 patients had satisfactory results whereas 5 cases were considered clinical failures (with recurrent instability in 3 and pain in 2). There was clinically significant improvement in pain score (6 preoperatively v 2 postoperatively, P = .0001), Simple Shoulder Test score (6 preoperatively v 10 postoperatively, P = .001), and American Shoulder and Elbow Surgeons score (50 preoperatively v 76 postoperatively, P = .001). Of the 9 Workers' Compensation patients, 5 were able to return to their original work.


CONCLUSIONS
Arthroscopic revision instability repair by use of a combination of suture anchors, plication stitches, and rotator interval closure can result in a satisfactory outcome in selected patients.


METHODS
Level IV, therapeutic case series.
Creighton
R Alexander
RA
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. alex_creighton@med.unc.edu
Romeo
Anthony A
AA
Brown
Fredrick M
FM
Hayden
Jennifer K
JK
Verma
Nikhil N
NN
D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology; D016059:Range of Motion, Articular; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome