Recurrent Posterior Shoulder Instability: Diagnosis and Management

Arthroscopic Distal Tibial Allograft Augmentation for Posterior Shoulder Instability With Glenoid Bone Loss

“…Patients with recurrent instability typically recall a single event that initiated the process, followed by repeated episodes of apprehension or instability with positional progression from extremes of motion to midrange motion. 4,5,8 Standard radiographs (anteroposterior, axillary lateral) may appear normal, but careful examination can detect subtle abnormalities that can predispose to posterior instability, such as glenoid hypoplasia, posterior rim deficiency, and glenoid retroversion. Magnetic resonance imaging is useful to detect capsuloligamentous pathology and articular cartilage loss.…”

“…Three-dimensional reconstructions with humeral head subtraction can improve the accuracy of quantifying the extent of glenoid bone loss. 1,[4][5][6] It is well recognized that anterior glenoid bone loss is a significant contributor to recurrent anterior instability if the defect amounts to greater than 25% of the articular surface. The current gold-standard treatment for glenoid bone loss in the setting of recurrent instability is a coracoid transfer with the Bristow-Latarjet procedure.…”

“…As such, bone augmentation procedures for posterior glenoid bone loss have been described in a similar fashion to anterior glenoid bone loss to prevent recurrent instability (Table 1). [4][5][6] In this technique article with video, we describe an arthroscopic technique using fresh distal tibial allograft for posterior glenoid augmentation.…”

Arthroscopic Posterior Labral Repair and Capsular Shift With a Lateralized Posterior Portal

“…[8][9][10] More recently, arthroscopic techniques have shown good results. [1][2][3][4][5][6][7] Although most surgeons are comfortable with anterior labral repair, arthroscopic procedures about the posterior glenoid and capsule can be more difficult because of their relative infrequency.…”

“…When one is addressing posterior labral pathology, surgical techniques using 2 portals posteriorly for anchor placement and suture manipulation have been published. 1,2 Other reports relate the use of an accessory portal for anchor placement. [3][4][5] Still other reports describe a surgical technique for addressing posterior labral pathology with a lateralized posterior portal that is used initially for viewing but is also in the correct location for anchor placement and capsular repair.…”