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Arthroscopic Posterior Labral Repair and Capsular Shift for Traumatic Unidirectional Recurrent Posterior Subluxation of the Shoulder

Investigation performed at the Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea

Seung-Ho Kim, MD
Yong-Seuk Lee, MD
Jong-Youl Lee, MD
Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea. E-mail address for S.-H. Kim: smcknot{at}hotmail.com

Kwon-Ick Ha, MD
Department of Orthopaedic Surgery, Seoul Veterans Hospital, 6-2 Dunchon-Dong, Kangdong-Ku, Seoul 134-791, Korea

Jong-Hyuk Park, MD
Department of Orthopaedic Surgery, Jeonbuk University Hospital, 643-18 Geumam-Dong, Duckjin-Don, Jeonju, Jeonbuk 561-172, Korea
Young-Min Kim, MDDepartment of Orthopaedic Surgery, Masan Samsung Hospital, 50 Hapsung-Dong, Masan, Kyungsangnam-Do 630-522, Korea

Jae-Chul Yoo, MD
Department of Orthopaedic Surgery, Eulji University School of Medicine, Eulji Medical Center, 280-1 Hagae-Dong, Nowon-ku 139-711, Korea

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The purpose of this study was to evaluate the results of arthroscopic treatment of traumatic unidirectional recurrent posterior subluxation of the shoulder.

Methods: We treated twenty-seven patients who had traumatic unidirectional recurrent posterior subluxation of the shoulder with arthroscopic labral repair and posterior capsular shift, and we evaluated them at a mean of thirty-nine months postoperatively. Patients who had posteroinferior instability, multidirectional instability, or an atraumatic onset or who were undergoing revision were excluded. There were twenty-five male and two female patients with a mean age of twenty-one years (range, fourteen to thirty-three years). All patients were involved in sports activity, and all had had a substantial injury prior to the onset of the instability. Results were assessed on the basis of stability, motion, and UCLA (University of California at Los Angeles), ASES (American Shoulder and Elbow Surgeons), and Rowe scores. Pain and function were also evaluated with visual analog scales.

Results: All patients had one or more lesions in the posteroinferior aspect of the labrum and capsule. The most common finding was incomplete stripping of the posteroinferior aspect of the labrum (eighteen patients). At the arthroscopy, the posteroinferior aspect of the capsule appeared to be stretched in twenty-two patients. At the time of follow-up, all patients had improved shoulder function and scores (p < 0.01). All patients also had a stable shoulder according to subjective and objective measurements, except for one patient who had recurrent subluxation. Except for that patient, all patients were able to return to their prior sports activity with little or no limitation. Shoulder function was graded as >90% of the preinjury level in twenty-four patients. There were twenty-one excellent UCLA scores, five good scores, and one fair score. The average pain score improved from 4.5 points preoperatively to 0.2 point at the time of follow-up (p < 0.0001). The mean loss of internal rotation was one vertebral level. There were no operative complications.

Conclusions: 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.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

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