Arthroscopic capsulolabral revision repair for recurrent anterior shoulder instability

Background: Primary arthroscopic Bankart repair for anterior shoulder instability demonstrates reliable outcomes, yet recurrence rates range from 4% to 60%, with revision required in up to 15% of cases. While bone-block procedures effectively address instability, they are associated with risks of graft osteolysis and premature osteoarthritis. Arthroscopic capsulolabral revision repair (ACRR) offers an anatomic alternative for patients without significant osseous defects.

Objective: This article details the preoperative risk assessment, surgical methodology, and clinical outcomes of ACRR for recurrent glenohumeral instability following failed soft-tissue stabilization.

Key Points: Successful ACRR requires rigorous patient selection. Contraindications include glenoid bone loss exceeding 10% of the inferior width, engaging Hill-Sachs lesions, and participation in collision sports. Preoperative evaluation must identify risk factors such as age under 20 years, male sex, and generalized joint hyperlaxity. The surgical technique involves extensive mobilization of the scarred capsulolabral complex, removal of previous hardware, and anatomic restoration using knotless all-suture anchors. For patients with significant capsular redundancy, a posteroinferior capsulolabroplasty is performed to reduce joint volume. Clinical data indicate that approximately 80% of patients achieve good to excellent functional outcomes, with return-to-sport rates between 78% and 84%. However, recurrent instability remains a concern, with reported weighted mean rates of 16% to 26% in the mid-term.

Conclusion: ACRR is an effective anatomic revision strategy for recurrent instability in the absence of critical bone loss. Precise identification of patient-specific risk factors and meticulous capsular management are essential for optimizing clinical success and minimizing recurrence.