Revision Arthroscopic Bankart Repair for Anterior Shoulder Instability After a Failed Arthroscopic Soft-Tissue Repair Yields Comparable Failure Rates to Primary Bankart Repair: A Systematic Review

Abstract

Background: The management of recurrent instability after arthroscopic Bankart repair remains challenging. Of the various treatment options, arthroscopic revision repairs are of increasing interest due to improved visualization of pathology and advancements in arthroscopic techniques and instrumentation. Purpose: We sought to assess the indications, techniques, outcomes, and complications for patients undergoing revision arthroscopic Bankart repair after a failed index arthroscopic soft-tissue stabilization for anterior shoulder instability. Methods: We performed a systematic review of studies identified by a search of Medline, Embase, and PubMed. Our search range was from data inception to April 29, 2020. Outcomes include clinical outcomes and rates of complication and revision. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively. Results: Twelve studies were identified, comprising 279 patients (281 shoulders) with a mean age of 26.1 ± 3.8 years and a mean follow-up of 55.7 ± 24.3 months. Patients had improvements in postoperative outcomes (eg, pain and function). The overall complication rate was 29.5%, the most common being recurrent instability (19.9%). Conclusion: With significant improvements postoperatively and comparable recurrent instability rates, there exists a potential role in the use of revision arthroscopic Bankart repair where the glenoid bone loss is less than 20%. Clinicians should consider patient history and imaging findings to determine whether a more rigorous stabilization procedure is warranted. Large prospective cohorts with long-term follow-up and improved documentation are required to determine more accurate failure rates.

Latarjet procedure for failed Bankart repair provides better stability and return to sports, but worse postoperative pain and external rotation limitations with more complications, compared to revision Bankart repair: a systematic review and meta-analysis

“…Several authors have recommended that the Latarjet procedure should be considered for the treatment of failed Bankart repair, owing to the low redislocation rates and good functional outcomes [8, 14, 41, 45]. However, the reported high complication rate in the Latarjet procedure is a concern for surgeons [9, 27]; thus, other authors recommend performing revision Bankart repair for patients with recurrent instability without critical bone loss [19, 20, 52].…”

“…In revision surgery, there is no definite indication for each surgical method (revision Bankart repair or Latarjet procedure for failed Bankart repair), and the Latarjet procedure could be performed even if the glenoid bone defect is minimal or does not exist, demonstrating good results [30, 44]. In addition, the previous Bankart repair surgery is a risk factor for poor outcomes after both revision Bankart repair and Latarjet procedure, and the results of the two revision surgery may be less predictable than those of the primary surgery [52, 62]. To the best of our knowledge, only two studies have compared the results of revision Bankart repair and Latarjet procedure in patients with failed Bankart repair [6, 12].…”

Outcomes of Revision Arthroscopic Posterior Labral Repair and Capsulorrhaphy: A Systematic Review

“…In recent years, there has been a shift to arthroscopic revision procedures, although few studies have specifically examined the outcomes of these procedures. While outcomes of revision arthroscopic labral repair and capsulorrhaphy have been the subject of much study, with numerous published results, 1 , 3 , 15 , 18 , 19 , 31 , 38 the outcomes of revision arthroscopic posterior instability surgery are largely unknown. In the current data set, the failure rate of arthroscopic revision posterior shoulder stabilization ranged from 21% to 75%, although only 1 of 26 patients underwent an additional surgical procedure.…”