Kim, J Bone Joint Surg Am 2003 - Arthroscopic Posterior Labral Repair and Capsular Shift for Traumatic Unidirectional Recurrent Posterior Subluxation of the Shoulder
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Arthroscopic Posterior Labral Repair and Capsular Shift for Traumatic Unidirectional Recurrent Posterior Subluxation of the Shoulder
Kim, Yoo, et al.·J Bone Joint Surg Am·2003·254 citations·Case series
Kim and colleagues assessed how athletes with recurrent posterior shoulder subluxation after a traumatic, one‑direction onset fared after arthroscopic labral repair with posterior capsular shift, and described the labral lesions found at surgery.
31 patients treated 1995 to 1999 at Samsung Medical Center, Seoul, with 27 reviewed at a mean of 39 months (range 24 to 85).
Methods
Design
All‑arthroscopic posterior labral repair with capsular shift, one surgeon
Treated 1995 to 1999
Patients
31 treated, 27 returned for final evaluation
25 male and 2 female
Mean age 21 (range 14 to 33)
All active in sports
Failed at least 6 months of nonoperative treatment
Excluded posteroinferior, multidirectional, voluntary or atraumatic instability
Excluded previous surgery
Mean follow‑up 39 months (range 24 to 85)
Basis
Arthroscopic appearance of the posteroinferior labrum
Key Findings
At final follow‑up, 26 of 27 shoulders were stable, and the one recurrence followed a new rugby injury 31 months after surgery.
All shoulder scores improved (p < 0.0001): UCLA from 21.9 to 33.4, ASES from 51.2 to 96.5 and Rowe from 35.6 to 94.6.
Mean pain on the visual analog scale fell from 4.5 before surgery to 0.2 at follow‑up (p < 0.0001).
No operative complications occurred, and internal rotation fell by a mean of one vertebral level.
The capsule over the labral lesion looked stretched in 22 of 27 patients, which the authors suggest makes the posterior band of the inferior glenohumeral ligament a contributor to posterior instability, especially in internal rotation at 90° of forward flexion.
Plain radiographs were normal in all 27 patients, while MR arthrography was abnormal in 20 of 27.
Board pearl
A Type II marginal crack hides a deep labral detachment, and the authors convert it to a complete tear and repair it with the posterior band of the IGHL.
Authors' conclusion
Arthroscopic posterior labral repair and capsular shift to treat traumatic unidirectional recurrent posterior subluxation is a reliable procedure with respect to providing stability, pain relief, and functional restoration.
Kim and colleagues assessed how athletes with recurrent posterior shoulder subluxation after a traumatic, one‑direction onset fared after arthroscopic labral repair with posterior capsular shift, and described the labral lesions found at surgery.
31 patients treated 1995 to 1999 at Samsung Medical Center, Seoul, with 27 reviewed at a mean of 39 months (range 24 to 85).
Methods
Design
All‑arthroscopic posterior labral repair with capsular shift, one surgeon
Treated 1995 to 1999
Patients
31 treated, 27 returned for final evaluation
25 male and 2 female
Mean age 21 (range 14 to 33)
All active in sports
Failed at least 6 months of nonoperative treatment
Excluded posteroinferior, multidirectional, voluntary or atraumatic instability
Excluded previous surgery
Mean follow‑up 39 months (range 24 to 85)
Basis
Arthroscopic appearance of the posteroinferior labrum
Key Findings
At final follow‑up, 26 of 27 shoulders were stable, and the one recurrence followed a new rugby injury 31 months after surgery.
All shoulder scores improved (p < 0.0001): UCLA from 21.9 to 33.4, ASES from 51.2 to 96.5 and Rowe from 35.6 to 94.6.
Mean pain on the visual analog scale fell from 4.5 before surgery to 0.2 at follow‑up (p < 0.0001).
No operative complications occurred, and internal rotation fell by a mean of one vertebral level.
The capsule over the labral lesion looked stretched in 22 of 27 patients, which the authors suggest makes the posterior band of the inferior glenohumeral ligament a contributor to posterior instability, especially in internal rotation at 90° of forward flexion.
Plain radiographs were normal in all 27 patients, while MR arthrography was abnormal in 20 of 27.
Board pearl
A Type II marginal crack hides a deep labral detachment, and the authors convert it to a complete tear and repair it with the posterior band of the IGHL.
Authors' conclusion
Arthroscopic posterior labral repair and capsular shift to treat traumatic unidirectional recurrent posterior subluxation is a reliable procedure with respect to providing stability, pain relief, and functional restoration.