Capsulolabral augmentation for the management of posteroinferior instability of the shoulder

Background: Posteroinferior instability of the shoulder has been associated with capsular laxity. The purposes of the present study were to describe t he pathological morphology of the posteroinferior aspect of the glenolabral fossa in patients with primary posteroinferior instability and to prospect ively examine the efficacy of managing this instability with use of an arth roscopic posteroinferior capsulolabral augmentation procedure. Methods: Forty-one patients who had posteroinferior instability of the shou lder were managed with an arthroscopic shift of the posteroinferior aspect of the capsule to the adjacent labrum and were followed for a minimum of tw elve months. Thirty-two patients had a primary procedure, and nine had a re vision procedure. The mean duration of follow-up was twenty-eight months (r ange, twelve to sixty-nine months). All of the patients had presented with a symptomatic, positive finding on the jerk test and had participated in a minimum of six months of rehabilitation that had failed to relieve the symp toms. The patients were evaluated prospective with a motion and stability e xamination and the Simple Shoulder Test. In addition, they completed the Sh ort Form-36 Health Survey (SF-36) and a questionnaire on the outcome of tre atment. Results: Lesions affecting the posteroinferior aspect of the glenolabral co ncavity were seen in thirty-four patients (83 percent): five had labral det achment, seven had chondral or labral erosion, nine had capsular and synovi al stripping, and thirteen had a labral split or tear. The mean score (and standard deviation) on the Simple Shoulder Test improved from 5.5 +/- 3.4 p oints to 8.1 +/- 3.3 points (p = 0.0023), and two of the eight SF-36 parame ters improved significantly (p < 0.05). Conversely, nineteen patients who w ere receiving Workers' Compensation did not show any improvement in either of the two parameters. Thirty-five patients had improved stability of the s houlder, and the findings on all physical examinations had improved signifi cantly (p < 0.0001). Twenty-eight patients had a perception of residual sti ffness; this finding was in contrast to the mean score on the flexibility e xamination, which had not changed significantly at the time of the latest f ollow-up. Conclusions Posteroinferior instability of the shoulder is associated not o nly with capsular laxity but also with well defined lesions of the glenolab ral concavity. Arthroscopic capsulolabral augmentation to reduce posterior capsular laxity and to restore the depth of the glenolabral concavity has b een shown to be effective treatment of this condition after a mean duration of follow-up of twenty-eight months.