This Level IV case series evaluates arthroscopic posterior labral repair and capsular shift in 27 young athletes with strictly traumatic, unidirectional recurrent posterior shoulder subluxation. All patients failed at least 6 months of nonoperative management and were evaluated at a mean of 39 months postoperatively. Patients with atraumatic onset, multidirectional instability, or posteroinferior instability were explicitly excluded.
Posterior instability has historically been lumped together — traumatic and atraumatic, unidirectional and multidirectional. And the mixed results in older series reflect that imprecision. This paper establishes that when you rigorously isolate traumatic unidirectional cases (positive jerk test, sulcus sign <1+, stable contralateral shoulder, no voluntary component), arthroscopic repair is highly reliable.
In clinic, when a young athlete reports a distinct traumatic onset, purely posterior instability, and a positive jerk test, do not dismiss it as atraumatic laxity. Confirm the six diagnostic criteria, ensure 6 months of failed rehab, then offer arthroscopic repair with confidence. At arthroscopy, always probe a type-II marginal crack. The surface looks superficial but the deep attachment is detached, and missing it leaves a loose repair.
The expected trade-off is one vertebral level of internal rotation loss, which is acceptable for return to sport at 4-6 months.
This Level IV case series evaluates arthroscopic posterior labral repair and capsular shift in 27 young athletes with strictly traumatic, unidirectional recurrent posterior shoulder subluxation. All patients failed at least 6 months of nonoperative management and were evaluated at a mean of 39 months postoperatively. Patients with atraumatic onset, multidirectional instability, or posteroinferior instability were explicitly excluded.
Posterior instability has historically been lumped together — traumatic and atraumatic, unidirectional and multidirectional. And the mixed results in older series reflect that imprecision. This paper establishes that when you rigorously isolate traumatic unidirectional cases (positive jerk test, sulcus sign <1+, stable contralateral shoulder, no voluntary component), arthroscopic repair is highly reliable.
In clinic, when a young athlete reports a distinct traumatic onset, purely posterior instability, and a positive jerk test, do not dismiss it as atraumatic laxity. Confirm the six diagnostic criteria, ensure 6 months of failed rehab, then offer arthroscopic repair with confidence. At arthroscopy, always probe a type-II marginal crack. The surface looks superficial but the deep attachment is detached, and missing it leaves a loose repair.
The expected trade-off is one vertebral level of internal rotation loss, which is acceptable for return to sport at 4-6 months.