Inferior capsular shift for multidirectional instability following failed laser-assisted capsular shrinkage

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Shoulder Instability Research

Background:

• Multidirectional instability (MDI) of the shoulder often requires surgical intervention.
• Previous attempts at minimally invasive treatments like laser-assisted capsular shrinkage (LACS) may fail.
• Evaluating salvage procedures for recurrent or persistent shoulder instability is crucial.

Purpose of the Study:

• To assess the efficacy of open inferior capsular shift (OICS) in patients with MDI after prior failed LACS.
• To determine if previous LACS negatively impacts the outcomes of OICS.

Main Methods:

• Prospective study of 10 consecutive patients with MDI undergoing OICS via an anterior approach.
• Patients had a history of failed LACS.
• Outcomes were evaluated using the Rowe, Constant, and a numeric satisfaction scale, with a mean follow-up of 33 months.

Main Results:

• 9 out of 10 patients achieved excellent results based on the Rowe system.
• Significant improvements were observed in Rowe (37.5 to 94), Constant (73 to 90.4), and satisfaction (1.6 to 7.7) scores (P <.001).
• No complications were reported; the single poor outcome was in a patient with multiple prior stabilization attempts.

Conclusions:

• Open inferior capsular shift is a viable and effective treatment for multidirectional shoulder instability.
• Prior failed laser-assisted capsular shrinkage does not appear to compromise the success of subsequent open inferior capsular shift.
• This surgical approach offers favorable outcomes for complex shoulder instability cases.