Revision Stabilisation

Causes for failure


1.  Patient factors


A.  Recurrent Trauma

- contact athletes higher risk


B.  MDI / Ligamentous Laxity / Voluntary dislocaters


C.  Poor rehabilitation

- poor motivation

- too rapid

- patients rarely get stiff, better to go very slow


2.  Surgeon Factors


A.  Unrecognised bony defect

- large bony bankart

- large engaging Hill Sachs


B.  Non Anatomical repair


C.  Poor sutures / poor knots / insufficient anchors


D. Unaddressed capsular laxity / Laxity RC interval / poor anterior labrum


E.  Posterior capsular tear / incorrect diagnosis / MDI




Identify cause of recurrent instability



- traumatic or atraumatic






- large Hill Sachs

- large Bony Bankart



- assess anchor position

- reassess labral repair / integrity




Long period non operative

- best results if muscle control  and strength are optimal


Revision Options


1.  Revision arthroscopic stabilisation



- no bony defect

- poorly done original surgery

- traumatic redislocation



- repair labrum

- capsular plication

- +/- rotator interval closure


2.  Open stabilisation



- as above


3.  Laterjet



- bony defect

- large Hill Sachs


Results of revision surgery in those without bony defects


Arthroscopic revision post failed arthroscopic stabilisation


Franchesci et al Am J Sports Med 2008

- revision labral repair / capsular plication +/- rotator interval closure

- 1 failure


Arthroscopic revision post failed open stabilisation


Boileau et al Arthroscopy 2009

- 22 cases post Latarjet and open Bankart

- arthroscopic labral reattachment / capsular plication +/- rotator interval closure

- 1 recurrent subluxation and 2 with positive apprehension


Open revision


Levine et al Am J Sports Med 2000

- 49 shoulders treated with capsular shift +/- Bankart repair if needed

- all patients who had a traumatic redislocation had a good result

- only 67% of patients with atraumatic recurrent instability had a good results




Case 1


Recurrence of instability without trauma

- anchors very high

- into glenoid face

- MRI suggests remaining inferior bankart

- no bony deficiency, no HAGL


Failed Open Stabilisation APFailed Open Stabilisation LateralFailed Open Stabilisation CT AxialFailed Open Stabilisation CT Sagittal


Failed Open Stabilisation MRIFailed Open Stabilisation MRI 2


Case 2


Recurrent instability

- non recognised bony defect

- revised with Latarjet


Revison Shoulder Stabilisation CT Bony DefectRevision Shoulder Stabilisation Bony Defect 2Revision Stabilisation with Latarjet