AANA Lab Course 904 - Shoulder Superstars: Everything You Can Do in a Shoulder Through the Scope! (APEx)-Case Presentation_ Failed Arthroscopic Bankart; What Now

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This presentation by Dr. Michael J. O’Brien from Tulane University addresses the complex issue of failed arthroscopic Bankart repairs used to treat shoulder instability. Failed stabilization is challenging, often causing significant patient and surgeon frustration. Common reasons for failure include unrecognized glenoid or humeral bone loss, missed associated lesions such as HAGL (humeral avulsion of the glenohumeral ligament) or ALPSA (anterior labroligamentous periosteal sleeve avulsion), technical errors (e.g., too few suture anchors, anchors placed too medially, absence of capsular shift), and recurrent trauma.<br /><br />Comprehensive re-evaluation is crucial, involving detailed patient history, thorough physical examination assessing range of motion, strength, general and anterior shoulder laxity, and specialized imaging. Imaging techniques such as standard radiographs with Bernageau and West Point views, MRI arthrograms, and especially 3D CT scans with "en face" glenoid views are key to accurately quantify bone loss and identify soft tissue lesions. Bone loss as little as 13.5% significantly increases recurrence risk and worsens outcomes.<br /><br />Treatment decisions after failed repair depend largely on bone loss and associated pathology. Arthroscopic revision is favored for minimal bone loss (<15%) and correctable soft tissue lesions. Remplissage (filling the Hill-Sachs defect) can be added in certain cases. Open Bankart repair is recommended for collision athletes or hyperlaxity with moderate bone loss (10-20%). For substantial bone loss (>20%), bone augmentation procedures such as Latarjet or bone grafts (e.g., Eden-Hybinette, distal tibial allograft) are indicated.<br /><br />The case described—a 25-year-old woman with recurrent Bankart tear and HAGL lesion after initial 2-anchor repair—was managed with arthroscopic labral repair and open HAGL repair, followed by structured rehabilitation emphasizing early scapular control and progressive strengthening.<br /><br />In summary, failed arthroscopic Bankart repair requires careful assessment of failed pathology and bone loss using advanced imaging. Treatment selection—arthroscopic revision, open repair, or bone augmentation—must be individualized. Revision surgery is technically demanding with generally lower success rates than primary repair, underscoring the importance of precise diagnosis and surgical technique in initial stabilization.

Asset Caption

Dr. Michael J. O'Brien, M.D.

Keywords

failed arthroscopic Bankart repair

shoulder instability

bone loss quantification

HAGL lesion

ALPSA lesion

arthroscopic revision surgery

open Bankart repair

bone augmentation procedures

3D CT imaging

shoulder stabilization techniques