Research highlights role of revision arthroscopic stabilization with caveats for indications

ORLANDO, Fla. — Although a retrospective review of prospectively collected data for 91 shoulders undergoing revision anterior shoulder stabilization performed with either arthroscopic revision stabilization or Latarjet found satisfactory results with both procedures, recurrent instability rates were 19% with arthroscopic revision and 7% with Latarjet.

“Overall, we found that both revision arthroscopic stabilization and Latarjet result in satisfactory outcomes. But despite small degrees of glenoid bone loss, we found recurrent instability rates were higher in our arthroscopic revision group compared to our Latarjet group,” Rachel M. Frank, MD, said at the American Orthopaedic Society for Sports Medicine Annual Meeting, here.

The study included patients with a minimum follow-up of 18 months who underwent a prior stabilization procedure at least 15 months before the revision procedure. Four surgeons performed the revision procedures. Sixty-three shoulders underwent revision arthroscopy and 28 shoulders underwent Latarjet. Frank said the average glenoid bone loss in the Latarjet group approached 20% and half of the patients in this cohort had more than one prior stabilization attempt before the index arthroscopic stabilization.

Patients were evaluated using the WOSI, ASES, Simple Shoulder Test and Visual Analog Scale score for pain. The investigators defined failure as recurrent dislocation or symptomatic subluxation.

Both groups showed significant improvements in all patient-reported outcome scores, Frank said. The average WOSI score for the revision arthroscopy group was 80 vs. 71.9 in the Latarjet group. Of the 12 instability events in the revision arthroscopy group, five were from a contact sport; five had non-contact mechanisms and two were symptomatic subluxations at the time of follow-up without a frank dislocation. 

“When we looked at a regression analysis, risk factors for failure in the revision arthroscope group included the number of prior surgeries prior to the first index stabilization as well as a history of baseline hyperlaxity on physical examination,” Frank said.

Of the two recurrent dislocations in the Latarjet group, one was sustained from a motocross activity and progressed to rapid arthrosis. This patient ultimately underwent a hemiarthroplasty at 2 years following the Latarjet. The other patient had symptomatic subluxation without a frank instability event.

Frank said there is a role for revision arthroscopic stabilization “with the caveat that there needs to be strict indications. Index technical failure that can be improved may be addressed with arthroscopic stabilization depending on the patient, pathology and their activity levels and demands. The patient needs to have good capsular tissue in order to treat this with a scope.”

She added, “Based on these results, we caution you to do this in patients with greater than one prior surgical attempt at stabilization and/or baseline of hyperlaxity, even in the setting of minimal glenoid bone loss.” – by Gina Brockenbrough, MA

Reference:

Frank RM, et al. Paper #21. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 9-12, 2015; Orlando, Fla.

Disclosure: Frank reports no relevant financial disclosures.