My Arthroscopic Bankart Failed, Now What? Revision Treatment Options for Recurrent Instability Following Failed Anterior Arthroscopic Stabilization (2025 Annual Meeting)-My Arthroscopic Bankart Failed, Now What? Revision Treatment Options for Recurrent Instability Following Failed Anterior Arthroscopic Stabilization

My Arthroscopic Bankart Failed, Now What? Revision Treatment Options for Recurrent Instability Following Failed Anterior Arthroscopic Stabilization

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Video Summary

This expert panel discussion focuses on managing failed arthroscopic Bankart repairs, a common shoulder stabilization surgery with high failure rates (up to 30% at 10 years). The session covers treatment strategies including arthroscopic revision Bankart repairs (with or without remplissage), open Bankart repairs, and open or arthroscopic bone block procedures like the Latarjet technique. <br /><br />Key points include the importance of assessing glenoid bone loss, lesion tracking (on-track vs. off-track), and patient factors such as age, activity level, and hyperlaxity in surgical decision-making. Arthroscopic revision Bankart repair is favored for select patients with no or subcritical bone loss, older age, non-contact sports, and well on-track lesions. However, failure rates remain high, nearing 40% in some cohorts, especially in younger patients and those with off-track lesions.<br /><br />Open Bankart repair, though less commonly performed today, is valuable for patients with hyperlaxity or minimal bone loss, allowing better capsular volume and thickness management. The Latarjet procedure is more appropriate for significant bone loss or off-track lesions but carries higher complication rates, including nerve injury and nonunion.<br /><br />Bone block options like distal tibia allograft, iliac crest, distal clavicle, and scapular spine grafts are explored. Distal tibia grafts closely match glenoid curvature and cartilage but may be costly. Outcomes show bone remodeling normalizes the glenoid shape over time, emphasizing the need to avoid oversizing grafts.<br /><br />Arthroscopic anatomic glenoid reconstruction (AAGR) offers advantages combining stability akin to Latarjet with the safety and ease of arthroscopic surgery, facilitating better graft placement and reducing complications.<br /><br />Case discussions highlight the need for early imaging (MRI, CT) to quantify bone loss, individualized treatment plans, and caution in special populations like seizure patients, for whom bone block procedures without muscular attachments may reduce failure risk.<br /><br />Overall, the panel emphasizes careful patient selection, addressing bone loss anatomically, and tailoring surgical techniques to optimize long-term shoulder stability and function.

Asset Caption

Albert Lin, M.D. | Aman Dhawan, M.D. | Katherine J. Coyner, M.D, M.B.A. | Ivan H. Wong, M.D., FAANA

Keywords

arthroscopic Bankart repair

failed Bankart repair

shoulder stabilization surgery

glenoid bone loss

lesion tracking

arthroscopic revision Bankart

open Bankart repair

Latarjet procedure

bone block grafts

arthroscopic anatomic glenoid reconstruction

patient selection in shoulder surgery