title: Is selective arthroscopic revision beneficial for treating recurrent anterior shoulder instability?
abstract: BACKGROUND
  Surgeons have traditionally treated recurrent shoulder dislocation by open methods. With the advent of arthroscopic repair techniques some surgeons reported higher recurrence rates than with open methods but some of those reports included patients with a variety of problems, including bone loss and those continuing in contact sports. It is unclear whether recurrence rates would be higher in patients without bone loss and those willing to forego contact sports.
  
  
  OBJECTIVE
  We therefore determined recurrence rates and functional scores after arthroscopic revision shoulder stabilization in patients without bone loss and those not subsequently participating in contact sports.
  
  
  METHODS
  We retrospectively reviewed 16 patients who underwent a revision arthroscopic Bankart repair using suture anchors. An arthroscopic approach was selected in patients with a unilateral traumatic injury and mild to moderate bone loss. Arthroscopic stabilization was contraindicated in patients with (1) multidirectional shoulder instability; (2) greater than 25% glenoid bone loss; (3) a Hill Sachs lesion involving more than one-third of the articular surface of the humeral head; and (4) patients electing to continue pursuing contact sports. At followup, physical examination of both shoulders was conducted. Several functional scores (Rowe, UCLA, and Constant & Murley) were compiled. The minimum followup was 24 months (mean, 31 months; range, 24-46 months).
  
  
  RESULTS
  The UCLA score (22-31), Constant & Murley score (69-80), and Rowe score (33-80) all improved. Shoulder instability recurred in three of the 16 patients, two sustaining dislocations and one a subluxation. One recurrence was the result of new trauma and this patient underwent an open Latarjet procedure; the other two patients refused further surgery.
  
  
  CONCLUSIONS
  Revision arthroscopic Bankart repair using suture anchors was associated with a low recurrence rate and restoration of acceptable function in patients without bone loss and not participating in contact sports.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Instituto Argentino de Diagnóstico y Tratamiento, Marcelo T de Alvear 2400, Buenos Aires, Argentina. guillermorarce@ciudad.com.ar
authors.forename: Guillermo
authors.initials: G
authors.lastname: Arce
authors.forename: Francisco
authors.initials: F
authors.lastname: Arcuri
authors.forename: Diego
authors.initials: D
authors.lastname: Ferro
authors.forename: Enrique
authors.initials: E
authors.lastname: Pereira
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D001265:Athletic Injuries / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D016059:Range of Motion, Articular; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D053441:Suture Anchors; D016896:Treatment Outcome