Assessment of failed arthroscopic anterior labral repairs. Findings at open surgery

To assess capsulolabral lesions present in patients after unsuccessful arthroscopic procedures, we reviewed the records of 20 patients who had undergone open shoulder procedures after unsuccessful arthroscopic Bankart procedures for chronic shoulder instability. The Bankart lesion had initially been repaired arthroscopically by transglenoid sutures (N = 10), bioabsorbable tacks (N = 7), suture anchors (N = 2), or arthroscopic screws (N = 1). Five of the 20 patients (25%) had reinjuries to the shoulder after the arthroscopic procedure. The average time from the arthroscopic to the open procedure was 17.9 months. Overall, 12 of the 20 patients (60%) had healed Bankart lesions at the time of open surgery. Eight of the 20 patients (40%) were found to have persistent Bankart lesions, and 15 of the 20 patients (75%) were found to have redundant anterior capsules. The presence of a persistent Bankart lesion significantly correlated with postarthroscopic dislocation, and the presence of capsular laxity significantly correlated with postarthroscopic subluxation. We concluded that capsular laxity is difficult to quantify arthroscopically and is present in a significant percentage of patients with chronic traumatic shoulder instability. Failure to successfully treat either the Bankart lesion or capsular laxity at the time of an arthroscopic Bankart procedure may lead to postoperative instability.