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Arthroscopic capsulolabral revision repair for recurrent anterior shoulder instability
Christoph Bartl1, Katrin Schumann, Jochen Paul
1Department of Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany. christoph.bartl@uniklinik-ulm.de
Background:
Open capsulolabral repair is still considered the standard revision procedure for a failed anterior shoulder instability repair. To date, only a few studies have evaluated the outcome of arthroscopic revision instability repair.
Purpose:
This study was undertaken to assess the clinical outcome and postoperative sports activity level of arthroscopic revision stabilization using defined inclusion criteria and a standardized operative revision technique.
Study Design:
Case series; Level of evidence, 4.
Methods:
Fifty-six patients with recurrent anterior shoulder instability after an anatomic index procedure (open or arthroscopic) were included in the study. Arthroscopic revision repair was performed by a single surgeon using standardized suture anchor repair technique via an anteroinferior 5:30-o'clock approach. Patients were evaluated after a mean follow-up of 37 months (range, 25-72 months) with the Rowe, the Constant score, and the Simple Shoulder Test (SST). Return to sports, including sports level and discipline, were evaluated with a sports activity assessment tool.
Results:
For the revision repair, a minimum of 3 anchors were placed in the lower glenoid half. Recurrent instability after the revision procedure was found in 6 cases (11%). There were 4 recurrent instability cases caused by trauma and 2 atraumatic cases. Arthroscopic revision repair did not result in an additional loss of external rotation or additional subscapularis muscle insufficiency. The Rowe and Constant scores and the SST were significantly improved by the procedure. Eighty-six percent of the patients rated their result as good or excellent. Sports activity level was significantly improved by the procedure and the majority of patients returned to their previous sports level.
Conclusion:
Arthroscopic capsulolabral revision repair via the anteroinferior 5:30-o'clock approach achieves results comparable with open revision repairs with a low recurrent instability rate. Arthroscopic revision repair reached a high patient satisfaction, good clinical outcomes, and a high rate of return to sports. The results suggest that arthroscopic revision repair is a viable treatment option for selected patients with a failed index repair.