An operative technique for recurrent shoulder dislocations in older patients

Recurrent anterior shoulder dislocation in the elderly is not as exceptiona l as if was once thought to be. That anterior shoulder dislocation in older patients is caused by a rotator cuff fear through the posterior mechanism is well accepted. However, in the subset of patients who have multiple recu rrent or intractable dislocations develop, there may be combined pathologic conditions at work: large or massive rotator cuff fears together with ante rior capsulolabral injuries such as a Bankart lesion or fracture of the gle noid rim. These patients have multiple recurrences because of disruption of both the anterior and the posterior stability mechanisms. We suggest a pro cedure that provides anterior stabilization with the capsular shift techniq ue and that is supplemented by Bankart repair as necessary. The capsule tra nsfer is performed superiorly and posteriorly to close the defect in the cu ff. In this way a capsulodesis effect can be achieved that displaces the hu meral head downward and produces active centering of the head in the course of abduction. Use of only the anterior capsule for the shift, and not the subscapularis tendon, does not compromise subscapularis function. Between 1 990 and 1996, we used this technique to treat 16 patients older than 55 yea rs of age with multiple recurrent anterior shoulder dislocation and massive rotator cuff fear. We report the results for the first 10 patients with a minimum follow-up of 2 years (range 2 to 7 years) and an average follow-up of 52 months. There were 7 excellent results, 2 good results, and 1 fair re sult according to the Rowe criteria. None of the patients had a recurrence of the dislocation. All the patients regained full or functional range of m otion with stable shoulders, and most of them could perform activities of d aily living without limitation. The average Constant score was 83%. This pr ocedure appears to be successful in treating older patients with recurrent shoulder dislocation.