Operative treatment of posterior shoulder dislocations by posterior glenoidplasty, capsulorrhaphy, and infraspinatus advancement

Abstract

Posterior dislocations of the shoulder are rare, comprising only 4% of shoulder dislocations. Several operative procedures have been described in treating recurrent dislocations, and results have been varied. A retrospective review of eight shoulders in eight patients treated by posterior glenoidplasty with capsulorrhaphy and infraspinatus advancement revealed generally good results. Followup ranged from 10 to 114 months, with an average of 36 months. Seven patients were classified as recurrent traumatic dislocators and one as a recurrent atraumatic voluntary dislocator. Results graded as good, fair, and failure were based on pain, range of motion, return to activities, recurrence, and roentgenograms. Six patients had good results with return to full activity, full range of motion, no pain, no recurrence, and no degenerative changes of roentgenograms. One patient, who has not returned to athletic activities and has occasional pain and limited range of motion, was graded as a fair result. The patient classified as an atraumatic voluntary dislocator has occasional feelings of instability and slight pain with strenuous activity, but has not had a recurrence and has no difficulty with activities of daily living. She was also classified as a fair result. There have been no recurrences or degenerative changes on followup radiographs. Computerized tomography performed on two patients documented a definite change in orientation of the glenoid. We feel that glenoidplasty with capsular reefing and infraspinatus advancement, if performed carefully, provides an excellent operative treatment for recurrent posterior dislocations of the shoulder.

Posterior open wedge glenoid osteotomy provides reliable results in young patients with increased glenoid retroversion and posterior shoulder instability

“…These reliable outcomes are in contrast to Hawkins et al who reported recurrent instability in 7 out of 17 patients postoperatively following glenoid osteotomy [7]. Moreover, Hernandez and Drez (1986), following an average 3-year follow-up, reported two patients with "fair" and six patients with "good" results. The two patients with fair results suffered from recurrent instability and were not able to return to their previous level of activity [8].…”

“…Moreover, Hernandez and Drez (1986), following an average 3‐year follow‐up, reported two patients with “fair” and six patients with “good” results. The two patients with fair results suffered from recurrent instability and were not able to return to their previous level of activity [8]. Convincing results were presented by Bessems and Vegter (1995), who reported “excellent” Rowe scores for twelve shoulders and a “good” score for one shoulder with no recurrence at a median 9‐year follow‐up [1].…”

“…However, these publications go back as far as half a century, and used diagnostic and surgical techniques that are now obsolete, as well as being associated with signiicant complications [1]. Furthermore, the report of postoperative outcomes following PGO is very limited [1,[5][6][7][8]15]. Out of a total of six previously published studies in the literature, ive studies have been published before the year 2000 with only two studies utilizing advanced imaging technology for pre-and postoperative evaluation [5,6].…”

Open posterior stabilization for recurrent posterior glenohumeral instability

“…These include open soft-tissue procedures such as the posterior Bankart repair, 20,35 posterior capsular shift and plication procedures,* transfer of the subscapularis, 18,26 posterior transfer of the biceps tendon, 6,15,30 reconstruction of the posterior capsule by use of tensor fascia lata, 31 posterior Putti-Platt repair, 17,21 capsular shift through an anterior approach, 46 and arthroscopic posterior capsulolabral repair and capsular plication. 3,23,25,45,47 Bony reconstruction, such as rotational osteotomy of the humerus, 9,42 opening wedge osteotomy of the glenoid, 4,7,10,19,31,36,38 and bone block augmentation procedures 1,11,12,14,20,28,37 have been performed in cases of excessive retroversion of the humerus or glenoid or in cases of hypoplasia.…”