[Current aspects in the arthroscopic treatment of shoulder instability]

With regard to postoperative stability of the shoulder joint, the results yielded by the various arthroscopic refixation techniques are not as good as those obtained after open operation. The aim of this paper is to analyze the reasons for this and to present a new procedure which it is hoped will improve the arthroscopic results. The main reason for the high postoperative recurrence rate after arthroscopic joint stabilization seems to be that refixation of the capsule is not performed at the level of the lesion, but above it, because of the position of the subscapularis tendon. Another reason for the poor results of arthroscopy is that the enlarged capsule cannot be shortened as desired, because the glenoid labrum is used for refixation of the capsule. To improve the arthroscopic results we suggest basic changes of the procedure in cases with severe damage to the soft tissue at the antero-inferior aspect of the glenoid and/or in cases with an enlarged capsule: refixation of the capsule should not be carried out from inside the joint but from outside the capsule. To this end, we applied the so-called extraarticular screwing technique. Refixation is achieved by inserting small cannulated titanium screws by means of a special screwdriver. No metal is placed inside the joint. This technique requires a new portal, namely the so-called antero-inferior portal, which is placed 1.5 cm inferior to the coracoid process. If the precautionary measures described are duly observed, the musculocutaneous nerve cannot be damaged. The technique allows stable refixation of the capsule in the desired length by placement of one or two small screws in the center of the Bankart lesion. Our preference is based on experience with 83 patients with recurrent shoulder instability who were operated on by arthroscopic techniques.(ABSTRACT TRUNCATED AT 250 WORDS)