title: Outcomes of two surgical revision techniques for recurrent anterior shoulder instability following selective capsular repair.
abstract: BACKGROUND
  Conventional capsulolabral reconstruction for anterior shoulder instability fails with recurrent instability in up to 23% of cases. Few studies have evaluated surgical revision strategies and outcomes. The objective of this study was to evaluate clinical and radiographic outcomes in a homogeneous series of surgical revisions after selective capsular repair (SCR).
  
  
  OBJECTIVE
  Observed anatomic lesions can guide the choice between repeat SCR and coracoid transfer (Latarjet procedure).
  
  
  METHODS
  From January 2005 to January 2009, 11 patients with trauma-related recurrent anterior shoulder instability (episodes of subluxation and/or dislocation) after SCR were included. Mean age was 31 years (range, 19-45 years). At revision, a glenoid bony defect was present in six patients. Repeat SCR was performed in five patients and coracoid transfer in six patients.
  
  
  RESULTS
  After a mean follow-up of 40 months (range, 24-65 months), no patient had experienced further episodes of instability. However, four patients had a positive apprehension test. External rotation decreased significantly by more than 20° after both techniques. The Simple Shoulder Test, Walch-Duplay, and Rowe scores were 10.5, 79, and 85, respectively. No patient had a subscapularis tear. Of these 11 patients, nine were able to resume their sporting activities and eight reported being satisfied or very satisfied with the subjective outcome. Radiographs showed fibrous non-union of the coracoid transfer in one patient.
  
  
  CONCLUSIONS
  In patients with recurrent anterior shoulder instability after SCR, repeat SCR and coracoid transfer produce similarly satisfactory outcomes. The size of the glenoid bone defect may be the best criterion for choosing between these two procedures. However, open revision surgery may decrease the range of motion, most notably in external rotation.
  
  
  METHODS
  Level IV.
authors.affiliation: Toulouse-Purpan University Hospital Center, place Baylac, 31059 Toulouse cedex, France. nicolasbonnevialle@yahoo.fr
authors.forename: N
authors.initials: N
authors.lastname: Bonnevialle
authors.forename: A
authors.initials: A
authors.lastname: Ibnoulkhatib
authors.forename: P
authors.initials: P
authors.lastname: Mansat
authors.forename: M
authors.initials: M
authors.lastname: Rongières
authors.forename: M
authors.initials: M
authors.lastname: Mansat
authors.forename: P
authors.initials: P
authors.lastname: Bonnevialle
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017746:Joint Capsule / Q000601:surgery*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult