Reasons for failure after surgical repair of anterior shoulder instability.

A total of 41 patients presenting with recurrent anterior instability of the shoulder after surgical repair were followed up after a mean period of 49 months (range, 24-81 months). The failed procedures were arthroscopic Bankart repair in 25 cases, open Bankart repair in 6 cases, Eden-Hybinette procedure in 4 cases, rotational osteotomy in 2 cases, capsular T- shift operation in 1 case, Bristow-Latarjet in one case, and a J-bone graft procedure in one case. In one case the index procedure was unknown. At revision surgery, the findings were a defect of the anterior bony glenoid rim in 23 patients (56%), a large capsule in 9 (22%), and a laterally torn capsule in 2 (5%). In 7 patients (17%) a typical Bankart lesion with good capsule quality was found. At revision surgery, these lesions were addressed by a bone graft procedure in 21 cases and fixation of the rim fragment with screws in 2 cases. In the 9 patients with a large capsule, a T-shift operation was performed in 6 and a Bankart repair with capsulorrhaphy was performed in the remaining 3. In the 7 patients with a typical Bankart lesion, a Bankart repair was performed, and in the 2 patients with a laterally torn capsule, an open suturing technique was used. At follow-up, none of the patients had had further redislocation or subluxation. The Rowe score was excellent in 81% of the cases and good in 19%. In 19 patients (46%) no increase in arthritic change was detected on radiographic assessment at follow-up, whereas 13 (32%) showed an increase of 1 degree and 4 (10%) showed an increase of 2 degrees. The results show that good and very good outcomes can be achieved with surgical repair provided that the basic pathology of the unstable shoulder is taken into account.