THE TREATMENT OF POSTERIOR SUBLUXATION IN ATHLETES

Posterior instability in athletes is a diagnostic and therapeutic chal lenge. Athletes have recurrent posterior subluxations rather than true dislocations, and they have pain rather than instability, which makes the diagnosis difficult. The pathology is usually capsular laxity rat her than a true reverse Bankart lesion. There is not one diagnostic te st, including computed tomography (CT) arthrogram, magnetic resonance imaging (MRI), or arthroscopy, that will always help with the diagnosi s. Most athletes respond to conservative care with an exercise program designed to strengthen the posterior deltoid, the infraspinatus, and the teres minor; but, there is still a select group of athletes that c annot perform their sport after an extensive rehabilitation program. T he surgical options for these athletes are varied, and the results in most cases are less than ideal. A posterior capsulorrhaphy was perform ed to treat this problem. This was initially performed with a staple, but this technique has been abandoned for a suture capsulorrhaphy to a void staple problems. The 40 athletes treated operatively that had ade quate follow-up evaluation reflected a 40% failure rate. Most of the f ailures were related to ligamentous laxity and unrecognized multidirec tional instability not treated at the time of surgery. There may be su btle differences between a patient with posterior subluxation and mult idirectional instability; these must be differentiated before operatio n. Also, the higher the competitive level of athlete, the worse the ov erall results. The high-level athlete must be informed that even if hi s or her shoulder is stabilized, the functional results may not allow him or her to continue at the same competitive level.