Failed Arthroscopic Anterior Instability Repair: Case Example

  • Emmanouil Antonogiannakis
  • Emmanouil Brilakis
  • Anastasios Deligeorgis


This case report describes the management of a failed arthroscopic anterior instability repair. It is the case of a 24-year-old man who had been operated for the first time 3.5 years earlier due to anterior instability of his right shoulder undergoing an arthroscopic Bankart repair. He completed successfully the rehabilitation program and returned to his daily activities. One year after the operation, he sustained a new dislocation of his right shoulder due to a low-energy trauma. After that, the patient had two more episodes of anterior dislocation, the last one during his sleep. He was a recreational athlete, playing basketball, but he had stopped any sporting activity due to recurrent instability of his right shoulder. This right-handed young man was reoperated arthroscopically, and a bone block procedure was performed, combined with remplissage. One year after the reoperation, he had full ROM and function of his shoulder, and he returned not only to his daily activities but also to his sporting activities.

In conclusion, in this case of failed Bankart repair with significant glenoid and humeral head bone loss, arthroscopic reconstruction of the anterior glenoid using autologous bone graft with concomitant soft-tissue reconstruction and remplissage had a good subjective (patient satisfaction) and objective (shoulder ROM and function) outcome at 1-year follow-up. The described procedure provided a suitable solution for the management of failed arthroscopic anterior instability repair.


Shoulder arthroscopy Recurrent anterior instability Engaging Hill–Sachs Bone block Remplissage 


  1. 1.
    Taverna E, D’Ambrosi R, Perfetti C, Garavaglia G. Arthroscopic bone graft procedure for anterior inferior glenohumeral instability. Arthrosc Tech. 2014;3(6):e653–60.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Sugaya H, Moriishi J, Kanisawa I, Tsuchiya A. Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. J Bone Joint Surg Am. 2005;87(8):1752–60.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Kim SJ, Kim SH, Park BK, Chun YM. Arthroscopic stabilization for recurrent shoulder instability with moderate glenoid bone defect in patients with moderate to low functional demand. Arthroscopy. 2014;30:921–7.CrossRefGoogle Scholar
  4. 4.
    Burkhart S, De Beer J. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill–Sachs lesion. Arthroscopy. 2000;16(7):677–94.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Di Giacomo G, Itoi E, Burkhart S. Evolving concept of bipolar bone loss and the Hill–Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy. 2014;30(1):90–8.CrossRefGoogle Scholar
  6. 6.
    Taverna E, Golanò P, Pascale V, Battistella F. An arthroscopic bone graft procedure for treating anterior-inferior glenohumeral instability. Knee Surg Sports Traumatol Arthrosc. 2008;16:872–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Warner JJ, Gill TJ, O’Hollerhan JD, Pathare N, Millett PJ. Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with glenoid deficiency using an autogenous tricortical iliac crest bone graft. Am J Sports Med. 2006;34:205–12.CrossRefPubMedGoogle Scholar
  8. 8.
    Scheibel M, Kraus N, Diederichs G, Haas NP. Arthroscopic reconstruction of chronic anteroinferior glenoid defect using an autologous tricortical iliac crest bone grafting technique. Arch Orthop Trauma Surg. 2008;128:1295–300.CrossRefPubMedGoogle Scholar
  9. 9.
    Kraus N, Amphansap T, Gerhardt C, Scheibel M. Arthroscopic anatomic glenoid reconstruction using an autologous iliac crest bone grafting technique. J Shoulder Elbow Surg. 2014;23(11):1700–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Anderl W, Kriegleder B, Heuberer PR. All-arthroscopic implant-free iliac crest bone grafting: new technique and case report. Arthroscopy. 2012;28:131–7.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Brilakis E, Mataragas E, Deligeorgis A, Maniatis V, Antonogiannakis E. Midterm outcomes of arthroscopic remplissage for the management of recurrent anterior shoulder instability. Knee Surg Sports Traumatol Arthrosc. 2016;24(2):593–600.CrossRefGoogle Scholar
  12. 12.
    Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA. Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res. 1996;329:300–9.CrossRefGoogle Scholar

Copyright information

© ESSKA 2018

Authors and Affiliations

  • Emmanouil Antonogiannakis
    • 1
  • Emmanouil Brilakis
    • 1
  • Anastasios Deligeorgis
    • 1
  1. 1.3rd Orthopaedic DepartmentHygeia HospitalAthensGreece

Personalised recommendations