Arthroscopic stabilization of posterior shoulder instability

Abstract

Posterior shoulder instability is a rare and challenging condition with a complex patho-anatomy. The role of arthroscopic repair in the treatment remains poorly defined. The purpose of this study is to evaluate the result of arthroscopic stabilization procedures in patients with posterior shoulder instability. In this case series, we treated eighteen patients (19 shoulders) with posterior shoulder instability with either arthroscopic thermal capsular shrinkage (9 patients), capsulorrhaphy (3) or labral refixation (7). There were eight male and ten female patients with a mean age of 26 years. The study group included unidirectional (6 patients; PI), bi-directional (8; PII) and multidirectional posterior instability (5; MDI). The Rowe-score and DASH-score as well as subjective and objective evaluations of the patients function, range of motion, pain and instability were used as clinical outcome measurements. At a mean follow-up of 50 months, the Rowe-score improved significantly from 46 to 74 (P = 0.005). Four patients (21%) had recurrent instability after arthroscopic treatment (2 with generalized ligamentous laxity; 3 after thermal shrinkage). Analysis of postoperative DASH-scores showed a tendency toward inferior outcomes after thermal shrinkage and in patients with an a-traumatic origin of shoulder instability. We conclude that arthroscopic shoulder stabilization by either labral refixation or capsulorrhaphy is a safe and effective treatment for posterior shoulder instability. Thermal capsular shrinkage however showed poor results and should be abandoned for this indication.

BESS/BOA patient care pathways: Atraumatic shoulder instability

“…Papers regarding the surgical management of atraumatic instability were reviewed in isolation. The search yielded mainly Level IV evidence, [20][21][22][23][24][25][26][27][28] but there were three publications of Level II evidence, all from a prospective cohort study with controls. 22,23,27 However, all of these three publications were produced from the same single cohort of patients.…”

Return to Sport After Arthroscopic Treatment of Posterior Shoulder Instability

“…In recent decades, arthroscopic techniques for posterior shoulder instability have become more popular and accepted because they provide better postoperative results compared with open techniques. 7,9,10,23,27 During arthroscopy, it is important that the surgeon first determine the pathologic changes because numerous different lesions can be present in posterior instability including posterior labral tears or abrasions, posterior capsular disruption and redundancy, laxity of the rotator interval, and anterior labral injury. 2,9,21,24 Like most surgeons, we use the lateral decubitus position for posterior stabilizing procedures rather than the beachchair position.…”

Endoskopische Schultereingriffe: sicher und effizient

“…Posteriore Schulterinstabilitäten sind zwar seltener als anteriore, allerdings stellen sich sowohl die Diagnose als auch die Behandlung komplexer dar [67]. Aber auch bei beispielsweise rezidivierender posteriorer Instabilität des Glenohumeralgelenks erzielt die Kapselplikatur signi kante klinische Verbesserungen und geringe Raten an rezidivierenden Instabilitäten und Revisionsoperationen [68].…”