Arthroscopic Capsulolabral Reconstruction for Posterior Instability of the Shoulder

Abstract

Background: There are few reports in the literature detailing the arthroscopic treatment of unidirectional posterior shoulder instability. Hypothesis: Arthroscopic capsulolabral reconstruction is effective in restoring stability and function and alleviating pain in athletes with symptomatic unidirectional posterior instability. Study Design: Cohort study; Level of evidence, 2. Methods: One hundred eighty-three athletes (200 shoulders) with unidirectional recurrent posterior shoulder instability were treated with arthroscopic posterior capsulolabral reconstruction and underwent an evaluation at a mean of 36 months postoperatively. A subset of 117 shoulders of contact athletes was compared with the entire group of 200 shoulders. Patients were evaluated prospectively with the American Shoulder and Elbow Surgeons (ASES) scoring system. Stability, strength, and range of motion were evaluated preoperatively and postoperatively with standardized subjective scales. Methods of intraoperative soft tissue fixation as well as anchorless (n = 44) and anchored (n = 156) plications were recorded for each patient. Results: At a mean of 36 months postoperatively, the mean ASES score improved from 45.9 to 85.1 ( P < .001). There were also significant improvements in stability, pain, and function based on previously used scales ( P < .001). The contact athletes did not demonstrate any significant differences when compared with the entire cohort for any outcome measure. With regard to the method of internal fixation, patients who underwent capsulolabral plications with suture-anchors showed significantly greater improvement in ASES scores ( P < .001) and a higher rate of return to play ( P < .05) when compared with patients with anchorless capsulolabral plications. Conclusion: Arthroscopic capsulolabral reconstruction is an effective, reliable treatment for symptomatic, unidirectional recurrent posterior glenohumeral instability in an athletic population. Overall, 90% of patients were able to return to sport, with 64% of patients able to return to the same level postoperatively. With the incorporation of bone suture-anchors in capsulolabral reconstruction, patients had greater improvements in ASES scores and a higher rate of return to play.