Arthroscopic Posterior Labral Repair With Capsulorrhaphy and Anterior Interval Closure: Surgical Technique

Posterior glenohumeral instability, though less common than anterior instability, accounts for a substantial portion of operatively managed shoulder instability in active populations. Arthroscopic posterior capsulolabral repair restores the soft tissue structures of the shoulder to reduce recurrent instability. However, the described surgical techniques vary greatly. We present a reproducible technique for improving the quality and volume of tissue incorporated in the repair and using interval closure to further reduce recurrent instability rates.

Arthroscopic posterior capsulolabral repair is indicated for athletes and high-demand patients with recurrent instability who do not have significant glenoid or humeral bone loss. This can include first-time dislocators participating in high-risk sports and vocational activities.

Shoulder arthroscopy is performed in the lateral position with a posterior portal, a Wilmington portal, and 2 anterior portals. Viewing from the anterosuperior portal and working through the Wilmington portal, the capsulolabral complex is elevated from the posterior and inferior glenoid using electrocautery, followed by a liberator knife. The native labral footprint on the glenoid is prepared for repair using a hooded burr. Sutures are passed through the capsulolabral tissue with a self-retrieving device via the anteroinferior portal. A drill guide is advanced through the Wilmington portal, and the tissue is sequentially secured with knotless anchors along the posterior glenoid. The resulting construct forms a robust restraint to posterior instability. An arthroscopic rotator interval closure is then performed for further stability.

Outcomes of arthroscopic posterior capsulolabral repair are generally acceptable, with reported return-to-play rates >90% and recurrence rates <6%. Nevertheless, some concerns persist regarding the ability to return to sport at preinjury levels postoperatively.

Arthroscopic posterior capsulolabral repair with interval closure is an effective operation for addressing recurrent posterior shoulder instability. This technique optimizes the quality and volume of soft tissue incorporated into the repair and offers an additional layer of stability via interval closure.

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