Revision Arthroscopic Shoulder Instability Repair R. Alexander Creighton, M.D., Anthony A. Romeo, M.D., Fredrick M. Brown, Jr., R.N., M.S., Jennifer K. Hayden, R.N., and Nikhil N. Verma, M.D. Purpose: The purpose of this study was to report on a difficult patient population and to critically evaluate the role of revision arthroscopic stabilization surgery. Methods: Eighteen patients with failed traumatic instability repairs were treated with revision arthroscopic labral fixation and plication with a mean follow-up of 29.7 months (range, 24 to 48 months). There were 15 male patients and 3 female patients with a mean age of 28.6 years (range, 15 to 50 years). Of the 18 patients, 9 were Workers’ Compensation cases. The 18 patients had a mean of 1.55 surgeries before our revision surgery, with 9 having a component of thermocapsular shrinkage. The patients’ characteristics, operative techniques, and findings were recorded, and their clinical outcome was critically evaluated (via physical examination, visual analog pain scale, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, and Short Form 12). Results: The revision surgery incorporated a 4-portal technique via a mean of 4.6 suture anchors and 3 plication stitches, and 15 patients received a rotator interval closure. At the follow-up evaluation, 13 patients had satisfactory results whereas 5 cases were considered clinical failures (with recurrent instability in 3 and pain in 2). There was clinically significant improvement in pain score (6 preoperatively v 2 postoperatively, P = .0001), Simple Shoulder Test score (6 preoperatively v 10 postoperatively, P = .001), and American Shoulder and Elbow Surgeons score (50 preoperatively v 76 postoperatively, P = .001). Of the 9 Workers’ Compensation patients, 5 were able to return to their original work. Conclusions: Arthroscopic revision instability repair by use of a combination of suture anchors, plication stitches, and rotator interval closure can result in a satisfactory outcome in selected patients. Level of Evidence: Level IV, therapeutic case series. Key Words: Shoulder—Instability—Revision—Arthroscopic. R ecurrent instability after operative intervention for traumatic unidirectional anterior shoulder in- stability is a difficult problem for both the patient and treating physician. Whereas recurrence rates for open surgery have been reported as less than 10%, the results from arthroscopic treatment are more variable, ranging from 0% to 43%. 1-6 Treatment options for failed shoulder instability repair include conservative care with physical therapy, bracing and activity mod- ifications, and revision surgical intervention. Revision surgery of failed shoulder instability repair has been addressed with open procedures with failure rates ranging from 8% to 39%. 7-12 To our knowledge, the clinical outcome of revision arthroscopic surgery for failed instability repair of the shoulder is not well known. In fact, there is only 1 clinical study on this topic in the literature. 13 The purpose of this study was to report our experience with this difficult patient population and to critically evaluate the outcome of our arthroscopic technique in revision cases. Our hy- pothesis was that arthroscopic techniques would have similar results with regard to elimination of instability when compared with more traditional open techniques. From the Department of Orthopaedics, The University of North Carolina (R.A.C.), Chapel Hill, North Carolina, and Midwest Orthopaedics at Rush, Rush University Medical Center (A.A.R., F.M.B., J.K.H., N.N.V.), Chicago, Illinois, U.S.A. Dr. Romeo has a consulting relationship with Arthrex, Naples, Florida. The other authors report no conflict of interest. Research was performed at Midwest Orthopaedics at Rush. Address correspondence and reprint requests to R. Alexander Creighton, M.D., Department of Orthopaedics, The University of North Carolina at Chapel Hill, 3134 Bioinformatics Bldg, Chapel Hill, NC 27599-7055, U.S.A. E-mail: alex_creighton@med.unc.edu © 2007 by the Arthroscopy Association of North America 0749-8063/07/2307-6180$32.00/0 doi:10.1016/j.arthro.2007.01.021 703 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 23, No 7 (July), 2007: pp 703-709