We analyzed the cases of 39 patients who were treated for recurrent anterior dislocation of the shoulder after unsuccessful surgical repair for the same condition in order to identify factors responsible for failure of the earlier operations and to determine the results of treatment of the post-surgical recurrence. The prior operations included 19 Bankart, 7 Putti-Platt, 5 Magnuson, 3 duToit, 2 Bristow, and 3 Nicola procedures. 32 shoulders were treated by reoperation. At reoperation the most common pathological lesion associated with recurrence of the dislocation after the prior repair was a Bankart lesion (avulsion of the capsule and labrum from the anterior glenoid rim). This was present in 84 per cent of the 32 shoulders that were treated by reoperation. Excessive laxity of the capsule was found in 83 per cent of the 29 shoulders in which laxity was assessed, and was considered to be the primary cause of instability in 4 shoulders. A Hill-Sachs lesion of the humeral head was found in 76 per cent of the 29 shoulders that were evaluated for this lesion and was large in 3 of the shoulders. Other factors that were associated with recurrent instability were scarring of the subscapularis muscle, generalized ligament laxity, technical errors at surgery, and severe reinjury. The success rate of reoperation after previous failure was very encouraging. Of the 24 shoulders that were reoperated on and were followed for 2 years or longer, 10 were graded excellent; 12, good; and 2, poor. One (4 per cent) of the 24 shoulders that were reoperated on continued to dislocate and another shoulder continued to subluxate, making the incidence of recurrent instability after reoperation 8 per cent. 7 of the 39 shoulders did not have a reoperation but were treated with specific resistive exercises. The results in these were one excellent, 4 good, one fair, and one poor. 8 patients were lost to follow-up.
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We analyzed the cases of 39 patients who were treated for recurrent anterior dislocation of the shoulder after unsuccessful surgical repair for the same condition in order to identify factors responsible for failure of the earlier operations and to determine the results of treatment of the post-surgical recurrence. The prior operations included 19 Bankart, 7 Putti-Platt, 5 Magnuson, 3 duToit, 2 Bristow, and 3 Nicola procedures. 32 shoulders were treated by reoperation. At reoperation the most common pathological lesion associated with recurrence of the dislocation after the prior repair was a Bankart lesion (avulsion of the capsule and labrum from the anterior glenoid rim). This was present in 84 per cent of the 32 shoulders that were treated by reoperation. Excessive laxity of the capsule was found in 83 per cent of the 29 shoulders in which laxity was assessed, and was considered to be the primary cause of instability in 4 shoulders. A Hill-Sachs lesion of the humeral head was found in 76 per cent of the 29 shoulders that were evaluated for this lesion and was large in 3 of the shoulders. Other factors that were associated with recurrent instability were scarring of the subscapularis muscle, generalized ligament laxity, technical errors at surgery, and severe reinjury. The success rate of reoperation after previous failure was very encouraging. Of the 24 shoulders that were reoperated on and were followed for 2 years or longer, 10 were graded excellent; 12, good; and 2, poor. One (4 per cent) of the 24 shoulders that were reoperated on continued to dislocate and another shoulder continued to subluxate, making the incidence of recurrent instability after reoperation 8 per cent. 7 of the 39 shoulders did not have a reoperation but were treated with specific resistive exercises. The results in these were one excellent, 4 good, one fair, and one poor. 8 patients were lost to follow-up.
Copyright remains with the authors and publisher.