Pollock, J Bone Joint Surg Am 2000 - Operative Results of the Inferior Capsular Shift Procedure for Multidirectional Instability of the Shoulder

Operative Results of the Inferior Capsular Shift Procedure for Multidirectional Instability of the Shoulder

Pollock, Bigliani, et al.·J Bone Joint Surg Am·2000·161 citations·Case series

Background

Neer and Foster previously described the inferior capsular shift procedure for treating multidirectional instability of the shoulder and reported preliminary results that were quite satisfactory. The purpose of our study was to perform a longer-term follow-up evaluation of the efficacy of the inferior capsular shift procedure for treating multidirectional instability of the shoulder.

Methods

An inferior capsular shift procedure was used to treat multidirectional instability of the shoulder in 49 patients (52 shoulders).
All patients had failed to respond to an exercise program.
In this series, the operative approach (anterior or posterior) was based on the major direction of the instability, as determined by the preoperative history and physical examination and as verified by examination with the patient under anesthesia.
In all of the patients, the inferior capsular shift was the primary attempt at operative stabilization.
The repair consisted of a lateral-side (or humeral-side) shift of the capsule to reduce capsular redundancy and, when necessary, a reattachment of the avulsed labrum to the anteroinferior aspect of the glenoid.

Results

A redundant capsular pouch was seen in all of the shoulders in this series.
In addition, detachment of the anteroinferior aspect of the labrum was found in 10 shoulders and an anterior fracture of the glenoid rim was seen in 2 shoulders.
At an average of 61 months (range, 24 to 132 months), results were available for 49 shoulders (46 patients).
30 shoulders (61 percent) had an excellent overall result, 16 (33 percent) had a good result, one (2 percent) had a fair result, and 2 (4 percent) had a poor result.
47 (96 percent) of the 49 shoulders remained stable at the time of follow-up.
2 of the 34 shoulders that had been repaired through an anterior approach began to subluxate anteroinferiorly again.
None of the 15 shoulders that had been repaired through a posterior approach had recurrent instability.
Full function, including the ability to perform strenuous manual tasks, was restored to 45 shoulders (92 percent).
A return to sports was possible after 31 (86 percent) of the 36 procedures done in athletes; however, a return to the premorbid level of participation was possible after only 25 (69 percent) of the 36 procedures.

Conclusions

The results in this series demonstrate the efficacy and the durability of the results of the inferior capsular shift procedure for the treatment of shoulders with multidirectional instability. The procedure directly addresses the major pathological feature - a redundant joint capsule. Similar results were seen with either an anterior or a posterior approach, and we continue to approach shoulders with multidirectional instability on the side of greatest instability. A postoperative brace was reserved for patients in whom a posterior approach had been used or in whom an anterior approach had involved extensive posterior capsular dissection (10 of the 34 shoulders treated with the anterior approach).

Supplemental

Operative Results of the Inferior Capsular Shift Procedure for Multidirectional Instability of the Shoulder

Pollock, Bigliani, et al.J Bone Joint Surg Am2000161 citationsCase series