Arthroscopic Repair of a Posterior Midcapsular Rupture Causing Posterior Shoulder Instability.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Arthroscopy

Background:

• Gross posterior shoulder instability is rare and often associated with posterior static restraint injuries.
• Diagnosing posterior capsular tears preoperatively is challenging with traditional MRI.
• Limited literature exists on arthroscopic repair of posterior capsular tears.

Purpose of the Study:

• To present a novel all-arthroscopic technique for repairing posterior midcapsular and posterior labral tears.
• To address recurrent posterior shoulder instability in a young patient.

Main Methods:

• A 26-year-old male underwent shoulder arthroscopy with a novel technique using accessory posterolateral and standard portals.
• A large posterior midcapsular rupture and associated posterior labral tear were identified.
• Anatomic closure of the capsular tear was achieved with sutures, followed by labral repair and capsular shift using knotless anchors.

Main Results:

• The patient regained symmetric motion and full strength at 6 months postoperatively.
• No residual pain or instability was reported.
• Estimated return to sport was achieved at 4 months.

Conclusions:

• Gross posterior instability is a difficult condition to diagnose and manage.
• Posterior capsular injury should be considered in cases of posterior instability, even without significant labral tears.
• This novel all-arthroscopic technique effectively repairs posterior capsular tears and addresses instability.