title: Revision posterior shoulder stabilization.
abstract: BACKGROUND
  Revision arthroscopic posterior glenohumeral stabilization requires a thorough understanding of the static and dynamic stabilizers of the glenohumeral joint. The evaluation of these patients is complex but critical given the variety of possible underlying lesions.
  
  
  METHODS
  We reviewed the literature surrounding recurrent and revision posterior instability biomechanics, etiology, evaluation, treatment, and outcomes. We also reviewed our own database of posterior instability cases and isolated revision procedures to review our own outcomes and to highlight overall concepts.
  
  
  CONCLUSIONS
  Although other authors have argued that performing a revision procedure indicates for an open procedure and osseous augmentation, our experience has been that revision posterior stabilization arthroscopic soft-tissue repair alone may be indicated in selected patients. After identification of posterior glenoid bone loss/effective retroversion and mechanical failure of prior repairs, the majority of the patients with recurrence of posterior instability likely have either recurrent or persistent labral pathology or patulous capsules with occult multi-directional instability primarily manifesting in the posterior direction. These patients are best served with capsular shift, reefing, and plication, often requiring 180-270° repair and 4 or greater suture anchors. Because of significant heterogeneity in the clinical outcomes reported to date further research will be necessary to define the clinical outcomes in revision posterior stabilization.
authors: Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison, Chicago, IL 60612, USA.
authors: Peter N
authors: PN
authors: Chalmers
authors: James
authors: J
authors: Hammond
authors: Tristan
authors: T
authors: Juhan
authors: Anthony A
authors: AA
authors: Romeo
mesh_terms: D001182:Arthroscopy; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012086:Reoperation; D012785:Shoulder Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
keywords: Level IV; Review Manuscript; Revision; arthroscopy; multidirectional instability; posterior instability; reoperation; shoulder instability