Arthroscopic Capsulolabral Reconstruction for Posterior Instability of the Shoulder

Abstract

Background:

There are few reports in the literature detailing the arthroscopic treatment of unidirectional posterior shoulder instability.

Hypothesis:

Arthroscopic capsulolabral reconstruction is effective in restoring stability and function and alleviating pain in athletes with symptomatic unidirectional posterior instability.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

One hundred eighty-three athletes (200 shoulders) with unidirectional recurrent posterior shoulder instability were treated with arthroscopic posterior capsulolabral reconstruction and underwent an evaluation at a mean of 36 months postoperatively. A subset of 117 shoulders of contact athletes was compared with the entire group of 200 shoulders. Patients were evaluated prospectively with the American Shoulder and Elbow Surgeons (ASES) scoring system. Stability, strength, and range of motion were evaluated preoperatively and postoperatively with standardized subjective scales. Methods of intraoperative soft tissue fixation as well as anchorless (n = 44) and anchored (n = 156) plications were recorded for each patient.

Results:

At a mean of 36 months postoperatively, the mean ASES score improved from 45.9 to 85.1 (P < .001). There were also significant improvements in stability, pain, and function based on previously used scales (P < .001). The contact athletes did not demonstrate any significant differences when compared with the entire cohort for any outcome measure. With regard to the method of internal fixation, patients who underwent capsulolabral plications with suture-anchors showed significantly greater improvement in ASES scores (P < .001) and a higher rate of return to play (P < .05) when compared with patients with anchorless capsulolabral plications.

Conclusion:

Arthroscopic capsulolabral reconstruction is an effective, reliable treatment for symptomatic, unidirectional recurrent posterior glenohumeral instability in an athletic population. Overall, 90% of patients were able to return to sport, with 64% of patients able to return to the same level postoperatively. With the incorporation of bone suture-anchors in capsulolabral reconstruction, patients had greater improvements in ASES scores and a higher rate of return to play.

Keywords

posterior instability capsulolabral reconstruction arthroscopic surgery shoulder

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References

Abrams

. Arthroscopic repair of posterior instability and reverse glenohumeral ligament avulsion lesions. Orthop Clin North Am. 2003;34:475-483.

Altchek

Warren

Skyhar

Ortiz

. T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types. J Bone Joint Surg Am. 1991;73:105-112.

Antoniou

Harryman

II . Posterior instability. Orthop Clin North Am. 2001;32:463-473.

Blasier

Soslowsky

Malicky

Palmer

. Posterior glenohumeral subluxation: active and passive stabilization in a biomechanical model. J Bone Joint Surg Am. 1997;79:433-440.

Bradley

Baker

III Kline

Armfield

Chhabra

. Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 100 shoulders. Am J Sports Med. 2006;34:1061-1071.

Fronek

Warren

Bowen

. Posterior subluxation of the glenohumeral joint. J Bone Joint Surg Am. 1989;71:205-216.

Hawkins

Koppert

Johnston

. Recurrent posterior instability (subluxation) of the shoulder. J Bone Joint Surg Am. 1984;66:169-174.

Kim

Park

. Arthroscopic posterior labral repair and capsular shift for traumatic unidirectional recurrent posterior subluxation of the shoulder. J Bone Joint Surg Am. 2003;85:1479-1487.

Kim

Sun

Park

. Arthroscopic capsulolabroplasty for posteroinferior multidirectional instability of the shoulder. Am J Sports Med. 2004;32:594-607.

10.

Misamore

Facibene

. Posterior capsulorrhaphy for the treatment of traumatic recurrent posterior subluxations of the shoulder in athletes. J Shoulder Elbow Surg. 2000;9:403-408.

11.

Neer

II Foster

. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder: a preliminary report. J Bone Joint Surg Am. 1980;62:897-908.

12.

Pollock

Bigliani

. Recurrent posterior shoulder instability: diagnosis and treatment. Clin Orthop Relat Res. 1993;291:85-96.

13.

Richards

Bigliani

. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg. 1994;3:347-352.

14.

Robinson

Aderinto

. Recurrent posterior shoulder instability. J Bone Joint Surg Am. 2005;87:883-892.

15.

Savoie

III Holt

Field

Ramsey

. Arthroscopic management of posterior instability: evolution of technique and results. Arthroscopy. 2008;24(4):389-396.

16.

Tibone

Bradley

. The treatment of posterior subluxation in athletes. Clin Orthop Relat Res. 1993;291:124-137.

17.

Tibone

Ting

. Capsulorrhaphy with a staple for recurrent posterior subluxation of the shoulder. J Bone Joint Surg Am. 1990;72:999-1002.

18.

Williams

Strickland

Cohen

Altchek

Warren

. Arthroscopic repair for traumatic posterior shoulder instability. Am J Sports Med. 2003;31:203-209.

19.

Wolf

Eakin

. Arthroscopic capsular plication for posterior shoulder instability. Arthroscopy. 1998;14:153-163.