THE ARTHROSCOPIC TREATMENT OF POSTERIOR SHOULDER INSTABILITY - 2-YEARRESULTS OF A MULTIPLE SUTURE TECHNIQUE

This study was undertaken to review the results of an arthroscopic pos terior capsular shift procedure. Twenty consecutive shoulders in 19 pa tients were treated with an arthroscopic posterior capsular shift for symptomatic posterior shoulder instability. Patients underwent the pro cedure if they exhibited a posterior Bankart lesion or had complaints of posterior instability and evidence of increased posterior joint lax ity on physical examination and examination under anesthesia. Twelve o f the 20 patients were injured during athletic activity. All surgeries were performed in an outpatient setting, Twelve of the 20 patients ha d posterior Bankart lesions and 10 had anterior Hill-Sachs lesions. Th e procedure entails releasing the posterior labroligamentous structure s from the posterior glenoid and freshening the glenoid neck with a bu r. A suture punch is used to place multiple absorbable monofilament st itches in the ligament complex. The stitches are brought through a sup raclavicular portal and tied over the clavicle or scapular spine. All 20 shoulders were evaluated at an average of 31 months postoperatively with a minimum follow-up of 24 months. Based on the outcome scale des cribed by Tibone and Bradley, the average postoperative score was 83 o ut of a possible 100, with 15 excellent, 2 good, 1 fair, and 3 poor re sults. There were two recurrent dislocations and three subluxations fo r an overall recurrence rate of 25%. All the recurrences occurred in p atients with posterior Bankart lesions and four of the five had a volu ntary component to their instability. There were no neurovascular comp lications or infections. Arthroscopic evaluation facilitated the diagn osis of posterior instability with the visualization of intra-articula r pathology that is difficult to identify during open procedures. Alth ough the majority of patients were able to return to vigorous activiti es, a recurrence rate of 25% is disturbing and consistent with recurre nce rates for open procerdures.