Arthroscopic Posterior Capsulolabral Reconstruction With Gracilis Allograft

Posterior shoulder instability is increasingly recognized and represents a complex continuum of pathology that can be challenging to diagnose and treat. Current surgical options involve posterior labral repair with or without capsular plication, as well as bony procedures, including glenoid bone grafting and glenoid osteotomy when indicated, often in the setting of revision. There is presently a dearth of surgical options to directly address the root cause of soft tissue failure, including a diminutive posterior labrum, chondrolabral retroversion, and thin or hyperelastic posterior capsule. This article presents a technique for arthroscopically augmenting the posterior capsulolabral complex in the setting of soft tissue insufficiency, laxity, or poor prognostic factors for failure. Secondarily, this technique provides a lower risk revision option for reconstruction in failed posterior instability without glenoid bone defect.