Multidirectional Instability of the Shoulder: A Systematic Review.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanical Research

Background:

• Multidirectional instability (MDI) of the shoulder is a complex condition characterized by excessive glenohumeral motion.
• Treatment options range from conservative management, including physiotherapy, to various surgical interventions.
• Determining the optimal treatment strategy for MDI remains a clinical challenge.

Purpose of the Study:

• To systematically review and analyze the outcomes of surgical versus conservative treatment for shoulder multidirectional instability (MDI).
• To compare the efficacy of different surgical techniques for managing MDI.
• To identify the most effective interventions following the failure of non-operative care.

Main Methods:

• A systematic literature review adhering to PRISMA guidelines was conducted.
• Databases searched included PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar (1966-2014).
• Keywords focused on shoulder instability, surgical procedures (capsular shift, plication), and conservative management.

Main Results:

• Twenty-four articles involving 861 shoulders (790 patients) were analyzed.
• Physiotherapy was insufficient for 21% of patients, necessitating surgery.
• Surgical redislocation rates varied: open capsular shift (7.5%), arthroscopic plication (7.8%), arthroscopic thermal shrinkage (24.5%), and arthroscopic laser-assisted capsulorrhaphy (22%).

Conclusions:

• Arthroscopic capsular plication and open capsular shift are recommended surgical procedures for MDI refractory to conservative treatment.
• Arthroscopic capsular plication demonstrates outcomes comparable to open capsular shift.
• These surgical techniques represent the best options after failure of rehabilitative management.