Operative results of the inferior capsular shift procedure for multidirectional instability of the shoulder

Background: Neer and Foster previously described the inferior capsular shif t procedure for treating multidirectional instability of the shoulder and r eported preliminary results that were quite satisfactory. The purpose of ou r study was to perform a longer-term follow-up evaluation of the efficacy o f the inferior capsular shift procedure for treating multidirectional insta bility of the shoulder. Methods: An inferior capsular shift procedure was used to treat multidirect ional instability of the shoulder in forty-nine patients (fifty-two shoulde rs). All patients had failed to respond to an exercise program. In this ser ies, the operative approach (anterior or posterior) was based on the major direction of the instability, as determined by the preoperative history and physical examination and as verified by examination with the patient under anesthesia. In all of the patients, the inferior capsular shift was the pr imary attempt at operative stabilization, The repair consisted of a lateral -side (or humeral-side) shift of the capsule to reduce capsular redundancy and, when necessary, a reattachment of the avulsed labrum to the anteroinfe rior aspect of the glenoid, Results: A redundant capsular pouch was seen in all of the shoulders in thi s series. In addition, detachment of the anteroinferior aspect of the labru m was found in ten shoulders and an anterior fracture of the glenoid rim wa s seen in two shoulders, At an average of sixty-one months (range, twenty-f our to 132 months), results were available for forty-nine shoulders (forty- six patients). Thirty shoulders (61 percent) had an excellent overall resul t, sixteen (33 percent) had a good result, one (2 percent) had a fair resul t, and two (4 percent) had a poor result. Forty-seven (96 percent) of the f orty-nine shoulders remained stable at the time of follow-up. Two of the th irty-four shoulders that had been repaired through an anterior approach beg an to subluxate anteroinferiorly again. None of the fifteen shoulders that had been repaired through a posterior approach had recurrent instability. F ull function, including the ability to perform strenuous manual tasks, was restored to forty-five shoulders (92 percent). A return to sports was possi ble after thirty-one (86 percent) of the thirty-six procedures done in athl etes; however, a return to the premorbid level of participation was possibl e after only twenty-five (69 percent) of the thirty-six procedures. Conclusions: The results in this series demonstrate the efficacy and the du rability of the results of the inferior capsular shift procedure for the tr eatment of shoulders with multidirectional instability. The procedure direc tly addresses the major pathological feature - a redundant joint capsule. S imilar results were seen with either an anterior or a posterior approach, a nd we continue to approach shoulders,vith multidirectional instability on t he side of greatest instability. A postoperative brace was reserved for pat ients in whom a posterior approach had been used or in whom an anterior app roach had involved extensive posterior capsular dissection (ten of the thir ty-four shoulders treated with the anterior approach).