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Open Capsulorrhaphy for Recurrent Multidirectional Instability of the Shoulder
Ioanna K Bolia1, Rebecca Griffith1, Nickolas Fretes1
1USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA.
Video Journal of Sports Medicine
|May 1, 2025
Summary
Open capsulorrhaphy effectively stabilizes shoulders with multidirectional instability (MDI), especially after failed arthroscopic procedures. This surgical technique helps athletes return to sport with a high success rate and low recurrence of instability.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Shoulder Instability
Background:
- Multidirectional instability (MDI) of the shoulder presents management challenges, particularly in athletes requiring revision surgeries.
- Both open and arthroscopic surgical approaches exist for shoulder MDI management.
Purpose of the Study:
- To describe the technique and outcomes of open capsulorrhaphy for shoulder multidirectional instability.
- To evaluate the efficacy of open capsulorrhaphy in athletes with tissue hyperlaxity and previous failed stabilization.
Main Methods:
- Open capsulorrhaphy via a deltopectoral approach.
- Subscapularis tenotomy, capsulotomy, and capsular repair with suture anchors.
- Augmentation with transosseous equivalent repair of the subscapularis tendon.
Main Results:
- Successful shoulder stabilization was achieved in a young female athlete with hyperlaxity and prior failed arthroscopic surgery.
- The athlete returned to sport at 6 months postoperatively with no recurrent instability episodes.
- Literature suggests 82%-97% success rates for open capsulorrhaphy in preventing recurrent MDI episodes.
Conclusions:
- Open capsulorrhaphy is a viable option for managing shoulder MDI, particularly in cases of tissue hyperlaxity and failed prior arthroscopic stabilization.
- Further research is needed to define optimal indications and outcomes for physically active patients, including those with connective tissue disorders.
