Forsythe Brian, Ghodadra Neil, Romeo Anthony A, Provencher Matthew T
OAK Orthopedics, S. Harlem Drive, Frankfort, IL, USA.
Sports Med Arthrosc Rev. 2010 Sep;18(3):149-61. doi: 10.1097/JSA.0b013e3181ec4397.
Although the results of operative treatment of posterior and multidirectional instability (P-MDI) of the shoulder have improved, they are not as reliable as those treated for anterior instability of the shoulder. This may be attributed to the complexities in the classification, etiology, and physical examination of a patient with suspected posterior and multidirectional instability. Failure to address the primary and concurrent lesion adequately and the development of pain and/or stiffness are contributing factors to the failure of P-MDI procedures. Other pitfalls include errors in history and physical examination, failure to recognize concomitant pathology, and problems with the surgical technique or implant failure. Patulous capsular tissues and glenoid version also play in role management of failed P-MDI patients. With an improved understanding of pertinent clinical complaints and physical examination findings and the advent of arthroscopic techniques and improved implants, successful strategies for the nonoperative and operative management of the patient after a failed posterior or multidirectional instability surgery may be elucidated. This article highlights the common presentation, physical findings, and radiographic workup in a patient that presents after a failed P-MDI repair and offers strategies for revision surgical repair.
尽管肩部后向和多方向不稳定（P-MDI）的手术治疗结果有所改善，但不如肩部前向不稳定的治疗结果可靠。这可能归因于疑似后向和多方向不稳定患者在分类、病因和体格检查方面的复杂性。未能充分处理原发性和并发病变以及疼痛和/或僵硬的出现是P-MDI手术失败的促成因素。其他陷阱包括病史和体格检查中的错误、未能识别合并的病理情况以及手术技术问题或植入物失败。松弛的关节囊组织和关节盂形态在失败的P-MDI患者的管理中也起作用。随着对相关临床症状和体格检查结果的理解不断提高，以及关节镜技术和改良植入物的出现，后向或多方向不稳定手术失败后患者的非手术和手术管理的成功策略可能会得到阐明。本文重点介绍了P-MDI修复失败后患者的常见表现、体格检查结果和影像学检查，并提供了翻修手术修复的策略。
