The Journal of Bone and Joint Surgery 82:1220 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
Capsulolabral Augmentation for the Management of Posteroinferior Instability of the Shoulder*
John Antoniou, M.D., PH.D., F.R.C.S.(C) ,
David T. Duckworth, M.D. and
Douglas T. Harryman, II, M.D.
Investigation performed at the Department of Orthopaedics,
University of Washington, Seattle, Washington
*No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Orthopaedic Research Laboratory, Royal Victoria Hospital, Room
L 4.69, 687 Pine Avenue West, Montreal, Quebec H3P 1H8, Canada.
E-mail address: janton{at}orl.mcgill.ca
116 Macguire Street, Parramatta, 2150 New South Wales, Australia.
Deceased.
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: Forty-one 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 twelve months. Thirty-two patients
had a primary procedure, and nine had a revision procedure. The
mean duration of follow-up was twenty-eight months (range, twelve
to sixty-nine months). All of the patients had presented with a
symptomatic, positive finding on the jerk test and had participated
in a minimum of six 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 thirty-four patients
(83 percent): five had labral detachment, seven had chondral or
labral erosion, nine had capsular and synovial stripping, and thirteen
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 two of the eight SF-36 parameters improved significantly (p < 0.05). Conversely,
nineteen patients who were receiving Workers' Compensation did not
show any improvement in either of the two parameters. Thirty-five
patients had improved stability of the shoulder, and the findings
on all physical examinations had improved significantly (p < 0.0001).
Twenty-eight 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 twenty-eight months.
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