Surgical repair for recurrent anterior instability of the shoulder

Background: The outcome of surgical repair for recurrent anterior instabili ty of the shoulder at the Wellington Hospital was reviewed. Methods: A retrospective review was undertaken of patients undergoing surgi cal repair for recurrent anterior instability of the shoulder at Wellington Hospital between October 1989 and November 1996. Patients were asked to co mplete two shoulder-specific questionnaires, and the range of motion, stabi lity, and strength was evaluated clinically. Results: A total of 37 patients (38 shoulders) who had recurrent anterior d islocation of the shoulder that was unresponsive to a physician-directed re habilitation programme were managed with open surgical repair. Procedures i ncluded the Putti-Platt, Bristow, Magnuson-Stack, Botychev, and Bankart rep airs. The mean age at the time of surgery was 24 years and the male-to-fema le ratio was 11.3:1. Surgery was performed on the dominant side in 63.2% of shoulders. The postoperative redislocation rate was 39.4% at an average of 4.6 years follow-up. Three patients have since required revision of their surgical repair and one patient is awaiting revision. A total of 63.2% of p atients were unable to return to their previous level of sports. Difference s existed between the motion in the surgically treated shoulder when compar ed with the contralateral side. Patients reported the most functional diffi culty in throwing, working overhead, pulling, and working at shoulder level . Conclusions: The results of the present study indicate a high redislocation rate, and highlight the challenges in restoring a stable, mobile, function al shoulder.