Arthroscopic labral reconstruction for anterior shoulder instability. Failure analysis in 187 patients

Comparing open with arthroscopic labral reconstruction for anterior shoulde r instability we found a higher recurrence rate after arthroscopic capsulol abral repair. The aim of this study was, to analyse the reasons for recurre nt instability after arthroscopic labral repair Materials and methods: Between 1989 and 1995 we performed a arthroscopic la bral reconstruction on 187 patients with anterior shoulder instability. 118 patients (63%) were treated with a transglenoid suture technique and 69 pa tient (37%) with a suture anchor technique. The average age at the time of the operation was 26.4 +/- 6,3 years (14-52 years). There were 41 women (21 .9%) and 146 men (78.1%) Results: The minimum follow-up was 18 months. The average follow-up was 3.7 +/- 1.1 years. The average Rowe Score increased from 34.7 points (0-75) pr eoperatively to 75.3 points (15-100) postoperatively. There were 47 (25.1%) excellent. 76 (40.6%) good, 21 (11.3%) fair, and 43 (23.0%) poor results. 105 patients (56.1%) regained their preoperative level of activity. 50 pati ents (26.7%) had recurrent subluxations or dislocations postoperatively. Al l failures occurred within two years (0.5-21 months) after the operation. F ailure rates were associated with the patients age (p < 0.001), the level o f activity (p < 0,05), the number of the preoperative dislocations (p < 0,0 1), the degree of the labral lesion (p < 0.001), and the operation method ( p < 0,05). No correlation was found for the parameters sex, handiness, time between luxation and operation, size of Hill-Sachs-lesion and numbers of u sed sutures or anchors. Conclusion: We prefer the arthroscopic suture anchor technique if there are less than 5 preoperative dislocation and a type 1 or 2 labral lesion. If t here are more than 5 preoperative dislocations and a degenerativ labrum def ect we favor the open Bankart repair technique.