Revision Treatment Options for Recurrent Instability Following Failed Anterior Arthroscopic Stabilization (AANA19)-Distal Clavicle Autograft for the Treatment of Shoulder Instability with Bone Loss-Dr. John M. Tokish, M.D.

Distal Clavicle Autograft for the Treatment of Shoulder Instability with Bone Loss-Dr. John M. Tokish, M.D.

Video Transcription

Video Summary

The speaker emphasizes the complexity of revision Bankart surgery, highlighting a high failure rate—three to four times that of primary surgeries—and stresses the importance of identifying why the initial surgery failed rather than blaming prior surgeons or patients. Risk factors for failure include capsular laxity, bone loss, and contact sports. Arthroscopic revisions show poor outcomes (~25% failure), and open revisions only slightly better (~23%). Bone block procedures, such as the Latarjet, offer superior results with low redislocation rates but carry risks like nerve injury and technical difficulty. The speaker advocates for mastering multiple surgical techniques—open Bankart, arthroscopic Bankart, and Latarjet—to tailor treatment per patient. A novel option discussed is using distal clavicle autograft for bone loss reconstruction, which is inexpensive, readily available, and provides adequate cartilage, promising a cost-effective alternative to distal tibia or iliac crest grafts. He concludes that revision shoulder instability surgery demands careful technique selection, thorough understanding, and cost-effective graft options.

Asset Caption

Instructional Course Lecture: Revision Treatment Options for Recurrent Instability Following Failed Anterior Arthroscopic Stabilization

Keywords

Revision Bankart surgery

High failure rate

Risk factors

Arthroscopic vs open revision

Bone block procedures

Distal clavicle autograft