This prospective study evaluated arthroscopic repair of bidirectional glenohumeral instability (inferior plus anterior or posterior component) in 54 patients. It asks whether arthroscopic repair can achieve a satisfactory mean Rowe score above 85 in this distinct instability pattern. Minimum follow-up was 2 years, with mean follow-up of 34 months.
Before this paper, bidirectional instability (inferior plus anterior or posterior) was often lumped into multidirectional instability and treated with open inferior capsular shift. Gartsman demonstrated that arthroscopic repair of this distinct pattern can match open outcomes — but only when all component lesions are addressed and patient selection is thoughtful.
When evaluating a patient with bidirectional instability, age and laxity are your two most important prognostic variables. Patients under 20 and those with generalized ligamentous laxity should receive explicit counseling about higher failure risk before you offer surgery.
When you see preoperative recurrent dislocation (rather than subluxation), expect a harder case. This subgroup averaged a Rowe score of 65.5, well below the good range. A shoulder stable at 18 months is likely to stay stable: no patient in this series with stability at that mark redislocated through 5-year follow-up, which gives a useful benchmark for postoperative reassurance.
This prospective study evaluated arthroscopic repair of bidirectional glenohumeral instability (inferior plus anterior or posterior component) in 54 patients. It asks whether arthroscopic repair can achieve a satisfactory mean Rowe score above 85 in this distinct instability pattern. Minimum follow-up was 2 years, with mean follow-up of 34 months.
Before this paper, bidirectional instability (inferior plus anterior or posterior) was often lumped into multidirectional instability and treated with open inferior capsular shift. Gartsman demonstrated that arthroscopic repair of this distinct pattern can match open outcomes — but only when all component lesions are addressed and patient selection is thoughtful.
When evaluating a patient with bidirectional instability, age and laxity are your two most important prognostic variables. Patients under 20 and those with generalized ligamentous laxity should receive explicit counseling about higher failure risk before you offer surgery.
When you see preoperative recurrent dislocation (rather than subluxation), expect a harder case. This subgroup averaged a Rowe score of 65.5, well below the good range. A shoulder stable at 18 months is likely to stay stable: no patient in this series with stability at that mark redislocated through 5-year follow-up, which gives a useful benchmark for postoperative reassurance.