Arthroscopic Revision surgery for shoulder Instability in Rugby players

Authors: Brendan Fourie & Lennard Funk

References: Presented at the International Sports Science & Sports Medicine Conference 2009

Introduction: Arthroscopic labral repair is a well recognised treatment for instability in the collision athlete but these athletes are predisposed to recurrent injury hence the potential for greater complications. 

Methods: A review of revision stabilisation procedures in rugby players with recurrent instability over a three year period (2005-2008) was performed.

Results: 18 revision stabilisation procedures were performed in 14 rugby players over a three year period.   The age range was 17-32 (mean of 23) years old.  11 patients played rugby league and 3 played rugby union.  12 players were professional athletes (1 semi-pro & 1 amateur).  6 players had previously undergone surgery by another surgeon but the remainder were by the senior author (LF).  The mean time between the primary and revision was 16.7 (5-60) months. All players had returned to playing rugby except 1 patient who had not completed rehabilitation from first operation.  Further intervention was precipitated by repeated injury in those that had returned to sport with the exception of one patient whose injury was not rugby related. At initial surgery 5 players had a Bankart lesion combined with a reverse Bankart (two also having a SLAP tear), 8 had Bankart injuries and 1 had a bony Bankart lesion. At revision it was noted that four repairs had partially healed while the remainder had failed completely.  Revision surgery was performed arthroscopically in 13 players (1 open Laterjet).  Four players required further procedures (3 Laterjet; 1 arthroscopic). 

Conclusions: There is a strong association between repair failure and repeated injury, but failures can be once again treated arthroscopically except in the presence of bone loss or poor quality tissue.