Primary labral repairs in the shoulder occasionally fail, prompting consideration of revision surgery of the original labral repair. Recognizing the appropriate time and justification for such procedures is key to optimizing patient outcomes. This article outlines when revision surgery becomes necessary, the underlying reasons, and essential patient evaluation considerations.
When Revision Surgery Is Warranted
Recurrent Dislocations or Subluxations
Patients who experience new episodes of shoulder dislocation or persistent subluxation after a primary repair are prime candidates for revision. Even episodes that don’t require manual reduction—subluxations—can indicate instability that may necessitate intervention. The recurrence rate after primary arthroscopic Bankart repair ranges from 5% to 15%, and revision is often recommended for recurrent instability.
Continued Instability and Functional Symptoms
Patients with ongoing subjective feelings of shoulder instability—such as apprehension, catching, or discomfort during certain positions—despite rehabilitation, are considered for revision surgery. These symptoms often signal underlying mechanical insufficiency.
Persistent Pain Even Without Apparent Instability
In some cases, patients report persistent shoulder pain or functional limitation after a primary repair, even if frank instability isn’t evident. Persistent pain alone, particularly when tied to mechanical labral pathology, can be an indication for revision.
Bone Deficiency and Engagement Patterns
Revision surgery is strongly indicated when significant bone loss is identified—particularly glenoid defects greater than 15–20%—or when an engaging Hill–Sachs lesion is present. These anatomical deficits often render soft tissue repair inadequate unless addressed surgically.
Poor Tissue Quality at Arthroscopy
During diagnostic or revision arthroscopy, surgeons may encounter tissue that is degenerated, frayed, or insufficient for standard repair. In these cases, reconstruction or augmentation with graft tissue may be considered instead of simple reattachment.
Patient-Specific Risk Factors
Younger patients (especially under age 22), individuals with ligamentous laxity or generalized hypermobility, and those participating in contact or overhead sports demonstrate higher failure rates and may benefit from early revision if symptomatic.
Decision-Making Considerations
- Imaging Evaluation: CT scans with 3D reconstructions are essential to quantify bone loss, assess Hill–Sachs lesions, and evaluate drill hole placements. MRI arthrograms help assess labral integrity and associated soft tissue pathologies.
- Instability Type: Anterior instability is most common (>80% of cases), but revision may also be indicated for posterior or multidirectional instability when symptomatic.
- Choice of Technique: In cases with minimal bone loss (<15%) and non-engaging Hill–Sachs lesions, arthroscopic revision repair (often using all-suture anchors) is a viable option. For larger bone deficiencies or structural instability, bone block procedures like Latarjet or grafting may be required.
Summary Table: Indications for Revision Surgery
| Indication | Description |
| Recurrent dislocation or subluxation | New episodes after primary repair |
| Subjective instability | Apprehension, catching despite rehab |
| Persistent pain | Mechanical pain without instability |
| Glenoid or humeral bone loss | Defects ≥ 15–20% or engaging Hill‑Sachs |
| Irreparable labral tissue | Tissue degeneration noted during arthroscopy |
| High-risk patient factors | Young age, hyperlaxity, high-demand sports |
Frequently Asked Questions
1. Is recurrent pain enough reason for revision surgery?
Yes—especially when imaging or arthroscopy shows ongoing labral pathology, even in the absence of dislocation.
2. Are all bone defects indications for revision?
Bone loss greater than ~15–20% or engaging lesions usually require surgery. Smaller defects may be managed with arthroscopic repair and adjunctive techniques.
3. Does patient age affect revision decision?
Younger patients—especially under 22—have higher rates of revision failure and may need earlier intervention.
4. Can revision be performed arthroscopically?
Yes, for many patients with minimal bone loss and intact labral tissue. Arthroscopic revision using all-suture anchors has shown favorable short-term outcomes.
5. What about those with multidirectional instability (MDI)?
MDI patients have modest revision success (~39%) and may require open capsular procedures rather than simple labral repair.
