[Recurrent instability and instability arthropathy]

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Shoulder Instability Research

Background:

• Anteroinferior shoulder instability often requires capsulolabral reconstruction (Bankart repair) in active patients.
• Despite good outcomes, recurrence rates after primary repair can reach 25%, influenced by patient and surgical factors.
• Recurrent instability necessitates thorough clinical and radiological evaluation, including CT scans for bone loss assessment.

Purpose of the Study:

• To review current treatment strategies for anteroinferior shoulder instability and recurrent dislocations.
• To identify risk factors for surgical failure and discuss management of complex cases.
• To explore options for engaging Hill-Sachs lesions and managing dislocation arthropathy.

Main Methods:

• Literature review of primary and revision shoulder stabilization techniques.
• Analysis of risk factors associated with recurrent shoulder instability.
• Evaluation of surgical options including Bankart repair, bone grafting (coracoid, iliac crest), Latarjet procedure, Remplissage, and arthroplasty.

Main Results:

• Bankart repair is first-line for active patients, but recurrence is significant.
• Glenoid bone loss and Hill-Sachs lesions are key factors in failed primary surgery.
• For recurrent instability, bony augmentation (Latarjet, bone blocks) offers better outcomes than revision Bankart repair alone.
• Engaging Hill-Sachs lesions require specific management; dislocation arthropathy presents as pain and restricted motion.

Conclusions:

• Revision surgery for shoulder instability requires careful consideration of bone loss and lesion type.
• Bony augmentation procedures like the Latarjet are effective for recurrent instability with bone loss.
• Joint-preserving options exist for dislocation arthropathy, but consensus on Hill-Sachs lesion treatment is pending.