Arthroscopic management of posterior instability

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Shoulder Arthroscopy

Background:

• Posterior shoulder instability is rare, accounting for 2-10% of cases, with a spectrum from dislocation to recurrent posterior subluxation (RPS).
• Improved clinical awareness, advanced imaging (e.g., MR arthrography), and specific physical tests enhance RPS identification in athletes.
• Recurrent posterior subluxation often involves subtle intra-articular pathology.

Purpose of the Study:

• To describe an anatomic-based arthroscopic approach for treating recurrent posterior subluxation (RPS) of the shoulder.
• To highlight the identification and repair of specific intra-articular pathologies associated with RPS.

Main Methods:

• Description of an arthroscopic surgical technique focusing on an anatomic repair.
• Emphasis on identifying and addressing posterior capsular laxity, capsulolabral complex detachment, and inferior capsular tears.
• Utilizes advanced imaging and specific physical examination tests for pre-operative diagnosis.

Main Results:

• The arthroscopic approach facilitates detailed identification of intra-articular lesions.
• Repair addresses key pathologies like posterior capsular laxity and labral detachment.
• Postoperative results following stabilization for RPS are generally good to excellent.

Conclusions:

• Anatomic arthroscopic repair is an effective treatment strategy for recurrent posterior subluxation (RPS).
• This approach allows for precise management of intra-articular pathology.
• While outcomes are favorable, further improvements in surgical techniques and patient selection may enhance results.