Clinical Outcomes Following Revision Shoulder Arthroscopic Capsulolabral Stabilization

Objectives: The purpose of this study was to assess clinical outcomes in patients following revision shoulder arthroscopic capsulolabral stabilization. The hypothesis was that revision arthroscopic stabilization would offer predictable clinical outcomes in appropriately selected patients. Methods: Sixty-two patients (63 shoulders) with failure of primary instability repairs were treated with revision arthroscopic shoulder stabilization at a mean follow-up of 46.9 ± 16.8 months (range, 15-78). Forty-six male patients and 16 females with a mean age of 23.2 ± 6.9 years (range, 14.7 - 47.2) met the inclusion criteria for the study. Revision arthroscopic stabilization was indicated in patients with recurrent instability with limited glenoid bone loss. Clinical outcomes were evaluated using validated patient reported outcome questionnaires including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, visual analog pain scale and Western Ontario Shoulder Instability Index. In addition, patients were queried for recurrent instability events (subluxation or dislocation) or revision surgery. Results: At final follow-up, the mean post-operative Western Ontario Shoulder Instability normalized score was 80.1 (range, 15.0 - 100). There were clinically significant improvements in American Shoulder and Elbow Surgeons scores from 63.7 pre-operatively to 85.1 post-operatively (P < 0.001), Simple Shoulder Test scores from 61.8 pre-operatively to 90.9 post-operatively (P < 0.001), and VAS pain scores from 2.89 pre-operatively to 0.81 post-operatively (P < 0.001). Recurrent instability occurred in 12 shoulders (19.0 %), with number of prior surgeries and hyperlaxity found to be significant risk factor for failure (P < 0.001 and P = 0.04, respectively). Conclusion: Arthroscopic revision stabilization of the shoulder can result in satisfactory outcomes in patients who have failed previous capsulolabral repair. Increased number of prior surgeries and hyperlaxity are predictive of poor outcome. Longer-term studies are required to determine whether similar results are maintained over time, and to provide guidance on focused clinical indications.