Management of the failed posterior/multidirectional instability patient

Although the results of operative treatment of posterior and multidirectional instability (P-MDI) of the shoulder have improved, they are not as reliable as those treated for anterior instability of the shoulder. This may be attributed to the complexities in the classification, etiology, and physical examination of a patient with suspected posterior and multidirectional instability. Failure to address the primary and concurrent lesion adequately and the development of pain and/or stiffness are contributing factors to the failure of P-MDI procedures. Other pitfalls include errors in history and physical examination, failure to recognize concomitant pathology, and problems with the surgical technique or implant failure. Patulous capsular tissues and glenoid version also play in role management of failed P-MDI patients. With an improved understanding of pertinent clinical complaints and physical examination findings and the advent of arthroscopic techniques and improved implants, successful strategies for the nonoperative and operative management of the patient after a failed posterior or multidirectional instability surgery may be elucidated. This article highlights the common presentation, physical findings, and radiographic workup in a patient that presents after a failed P-MDI repair and offers strategies for revision surgical repair.