Antoniou, J Bone Joint Surg Am 2000 - Capsulolabral Augmentation for the Management of Posteroinferior Instability of the Shoulder

Capsulolabral Augmentation for the Management of Posteroinferior Instability of the Shoulder

Antoniou, Harryman, et al.·J Bone Joint Surg Am·2000·165 citations·Prospective cohort

Background

Posteroinferior instability of the shoulder has been associated with capsular laxity. The purposes of the present study were to describe the pathological morphology of the posteroinferior aspect of the glenolabral fossa in patients with primary posteroinferior instability and to prospectively examine the efficacy of managing this instability with use of an arthroscopic posteroinferior capsulolabral augmentation procedure.

Methods

41 patients who had posteroinferior instability of the shoulder were managed with an arthroscopic shift of the posteroinferior aspect of the capsule to the adjacent labrum and were followed for a minimum of 12 months.
32 patients had a primary procedure, and 9 had a revision procedure.
The mean duration of follow-up was 28 months (range, 12 to 69 months).
All of the patients had presented with a symptomatic, positive finding on the jerk test and had participated in a minimum of 6 months of rehabilitation that had failed to relieve the symptoms.
The patients were evaluated prospectively with a motion and stability examination and the Simple Shoulder Test.
In addition, they completed the Short Form-36 Health Survey (SF-36) and a questionnaire on the outcome of treatment.

Results

Lesions affecting the posteroinferior aspect of the glenolabral concavity were seen in 34 patients (83 percent): 5 had labral detachment, 7 had chondral or labral erosion, 9 had capsular and synovial stripping, and 13 had a labral split or tear.
The mean score (and standard deviation) on the Simple Shoulder Test improved from 5.5 +/- 3.4 points to 8.1 +/- 3.3 points (p = 0.0023), and 2 of the 8 SF-36 parameters improved significantly (p < 0.05).
Conversely, 19 patients who were receiving Workers' Compensation did not show any improvement in either of the 2 parameters.
35 patients had improved stability of the shoulder, and the findings on all physical examinations had improved significantly (p < 0.0001).
28 patients had a perception of residual stiffness; this finding was in contrast to the mean score on the flexibility examination, which had not changed significantly at the time of the latest follow-up.

Conclusions

Posteroinferior instability of the shoulder is associated not only with capsular laxity but also with well defined lesions of the glenolabral concavity. Arthroscopic capsulolabral augmentation to reduce posterior capsular laxity and to restore the depth of the glenolabral concavity has been shown to be effective treatment of this condition after a mean duration of follow-up of 28 months.

Supplemental

Capsulolabral Augmentation for the Management of Posteroinferior Instability of the Shoulder

Antoniou, Harryman, et al.J Bone Joint Surg Am2000165 citationsProspective cohort