Posterior shoulder instability in athletes: surgical treatment with posterior bone block

Purpose of the study Sports activities requiring antepulsion, adduction and medial rotation can favor the development of posterior instability of the shoulder. Conservativ e treatment is indicated, but many techniques have been proposed in case of failure. All do not allow recovery of the same sports level. We report our experience with six cases of posterior shoulder instability treated with a Gosset posterior bone block. Material and methods We retrospectively reviewed cases treated between 1974 and 1995. Six athlet es, aged 17 to 34 years (mean 25 years) underwent posterior bone block surg ery using the Gosset procedure on their dominant shoulder. Three of the pat ients had experienced involuntary dislocation and three others involuntary and voluntary dislocation. One patient had a multidirectional hyperlaxity. Five patients had participated in rehabilitation programs for at least five months. Two patients had undergone unsuccessful bone block surgery in anot her unit. Results Stability and pain relief were achieved in all cases. Three patients recove red complete mobility. In the three others, mean limitation of mobility for the different sectors was 15 degrees. There has been no sign of osteoarthr osis at three years follow-up. All patients have resumed their sports activ ities, three at the same level. Discussion In our experience, most surgical techniques proposed for the treatment of p osterior shoulder instability are unsuccessful. The Gosset iliac bone block prolongs the articular surface. After consolidation, it allows sports acti vities requiring shoulder force and provides satisfactory mobility.