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Complications and Pitfalls-Recurrence

Recurrence is the most frequently reported complication after open and arthroscopic surgery for anterior instability. Recurrence may be secondary to new trauma or to atraumatic events.Patients with traumatic recurrence of their instability usually have better post-operative results after revision surgery than patients with atraumatic recurrence. The recurrence rate is related to the number of prior surgeries.

For example, Levine et al.It have shown that the recurrence rate in subjects who had one prior surgery was 17%, while in individuals with multiple failed prior surgeries it was 44%. The repetitive damage to the subscapularis and the capsule undoubtedly compromises further surgery and ultimate outcome.

A variety of factors can contribute to failure after open anterior instability surgery. The most common are incorrect diagnosis, incorrect or technically inaccurate surgical procedure, bone defect with loss of glenoid concavity, and anterior capsular deficiency. Examples of misdiagnosis are failure to recognize posterior or multidirectional instability patterns, failure to diagnose a significant voluntary component to the instability or failure to recognize and treat associated injuries.

Inaccurate or technically imprecise surgical procedures can also lead to recurrence.Subscapularis rupture is one such complication that can be devastating. Numerous studies have shown that residual Bankart lesions, under-corrected anterior capsular redundancy, and unrecognized laxity of the rotator interval will result in recurrent instability. As discussed previously, defects in the glenoid concavity due to a bony Bankart lesion or an anterior glenoid rim erosion lead to an increased risk of recurrence.

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