[Arthroscopic labral reconstruction for anterior shoulder instability. Failure analysis in 187 patients]

Comparing open with arthroscopic labral reconstruction for anterior shoulder instability we found a higher recurrence rate after arthroscopic capsulolabral repair. The aim of this study was, to analyse the reasons for recurrent instability after arthroscopic labral repair.

Between 1989 and 1995 we performed a arthroscopic labral reconstruction on 187 patients with anterior shoulder instability. 118 patients (63%) were treated with a transglenoid suture technique and 69 patient (37%) with a suture anchor technique. The average age at the time of the operation was 26.4 +/- 6.3 years (14-52 years). There were 41 women (21.9%) and 146 men (78.1%).

The minimum follow-up was 18 months. The average follow-up was 3.7 +/- 1.1 years. The average Rowe Score increased from 34.7 points (0-75) preoperatively to 75.3 points (15-100) postoperatively. There were 47 (25.1%) excellent. 76 (40.6%) good, 21 (11.3%) fair, and 43 (23.0%) poor results. 105 patients (56.1%) regained their preoperative level of activity. 50 patients (26.7%) had recurrent subluxations or dislocations postoperatively. All failures occurred within two years (0.5-21 months) after the operation. Failure rates were associated with the patients age (p < 0.001), the level of activity (p < 0.05), the number of the preoperative dislocations (p < 0.01), the degree of the labral lesion (p < 0.001), and the operation method (p < 0.05). No correlation was found for the parameters sex, handiness, time between luxation and operation, size of Hill-Sachs-lesion and numbers of used sutures or anchors.

We prefer the arthroscopic suture anchor technique if there are less than 5 preoperative dislocation and a type 1 or 2 labral lesion. If there are more than 5 preoperative dislocations and a degenerative labrum defect we favor the open Bankart repair technique.