Paper 132: Revision Arthroscopic Capsulo-labral Reconstruction for Recurrent Instability of the Shoulder

Abstract

It is well documented that the outcomes of primary arthroscopic anterior stabilisation procedures of the shoulder are as good as if not better than open procedures; the outcome of arthroscopic revision shoulder stabilisation procedures is less well known. The purpose of this study was to investigate the outcome of arthroscopic revision surgery for failed anterior stabilisation of the shoulder. Forty patients with failed primary open or arthroscopic anterior shoulder stabilisation who were treated with revision arthroscopic capsulo-labral reconstruction were followed for a mean of 36 (12-87) months. There were 34 males and 6 females with a mean age of 33.1 (15-48) years. The patients characteristics, index procedure technique, operative findings at revision surgery and clinical outcome was evaluated using patient record review, physical examination, Western Ontario Shoulder Instability Index, American Shoulder and Elbow Surgeons score and Health Status Questionnaire 12. At final follow up, mean +/− SD American Shoulder and Elbow Surgeons score was 81.1 +/− 21.0 (17.5-99.5). The mean +/− SD Western Ontario Shoulder Instability Index score was 68.2 +/− 22.8 (20-98.2). HSQ-12 mean scores for the eight domains were: 76.7, 95.1, 82.1, 82.6, 89.7, 74.1, 62.0 and 75.3. All patients maintained or demonstrated improved range of motion: mean +/− SD forward flexion was 165.5° +/− 18.6° (140°-185°). Mean +/− SD external rotation was 60° +/− 15.7° (40°-85°). When compared to external rotation for the contralateral side, no signficant difference was found (p = 0.78). Four patients (10%) experienced recurrent instability after the revision arthroscopic procedure. All of these occurred traumatically.We believe our series of revision arthroscopic capsulo-labral reconstructions to be the largest reported on in the literature. We have shown that in a carefully selected patient population, this procedure can provide stability in approximately 90% of patients, comparable to success rates of primary arthroscopic and open stabilisation procedures. Arthroscopic revision for recurrent instability of the shoulder should be considered as a reliable treatment option for this patient population except in the setting of significant gleno-humeral bone defects.