Evidence-Based Risk Factors for Failure of Arthroscopic Labral Repair

Arthroscopic labral repair, including Bankart and related capsulolabral and bony augmentation procedures, are the mainstay treatment for anterior shoulder instability in young, active patients but is limited by clinically meaningful failure rates. This review synthesizes contemporary evidence to define patient-, lesion-, and technique-related risk factors for failure after arthroscopic labral repair and links these risks to functional outcomes, return-to-sport (RTS), and patient-reported outcome measures (PROMs) to guide counseling and procedure selection.

Recurrent instability after modern arthroscopic Bankart repair ranges from approximately 15-30% at mid- to long-term follow-up, with age < 20 years emerging as a dominant predictor of failure. Glenohumeral bone loss, off-track or near-track Hill-Sachs lesions and joint hyperlaxity increase risk for failure. Technical factors such as using fewer than three anchors, and suboptimal anchor placement are linked to failure. Across adult, pediatric, and athletic cohorts, stable shoulders achieve good-to-excellent PROMs and high RTS rates, whereas recurrent instability worsens patient satisfaction. Failure after arthroscopic labral repair is driven by several patient- and surgical technique-specific risk factors. Quantification of bone loss and glenoid track, and incorporation of tools such as the Instability Severity Index Score and Pittsburgh Instability Tool can stratify risk and identify patients who may benefit from bone augmentation or remplissage. Despite high lifetime recurrence in some subgroups, most patients without failure achieve durable improvements in pain, function, and RTS, underscoring the importance of tailoring surgical strategy to individual risk profiles to optimize stability and PROMs over the long term.