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Open Revision Stabilization Surgery for Recurrent Anterior Glenohumeral Instability

William N. Levine, MD, Julian S. Arroyo, MD, Roger G. Pollock, MD, Evan L. Flatow, MD and Louis U. Bigliani, MD

Shoulder Service, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, New York

Presented at the interim meeting of the AOSSM, San Francisco, California, February 1997.

Address correspondence and reprint requests to William N. Levine, MD, 622 W. 168th St, PH 11–1117, New York, NY 10032

Fifty patients (average age, 27 years) who underwent revision anterior stabilization surgery for failed anterior glenohumeral instability procedures were retrospectively reviewed. Failure of the original procedure occurred subsequent to significant trauma in only 17 of 50 shoulders. At revision, 49 shoulders underwent an anteroinferior capsular shift procedure and 23 underwent concurrent repair of a Bankart lesion. One shoulder was treated with a coracoid transfer to reconstruct the anteroinferior glenoid. At an average follow-up of 4.7 years (range, 2 to 10), there were 36 excellent and 3 good results (78%). Eleven shoulders were considered unsatisfactory (22%); 7 of these 11 patients had a diagnosis of voluntary dislocation. All 17 patients who had failed results after significant trauma had excellent results after revision surgery. However, only 22 of the 33 patients (67%) with atraumatic recurrent instability achieved excellent or good results after revision surgery. This difference was statistically significant. No patients had radiographic evidence of osteoarthritis at the most recent follow-up. Range of motion, return to function, and glenohumeral stability can be reliably restored in a high percentage of patients after revision anterior stabilization surgery for glenohumeral instability. However, the results are not as predictable as for primary surgery. Factors associated with poor results of revision repair included an atraumatic cause of failure, voluntary dislocations, and multiple prior stabilization attempts.

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