Recurrent instability of the shoulder after age 40

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Shoulder Instability Research

Background:

• Recurrent shoulder instability is a common concern.
• Onset after age 40 presents unique challenges.
• Traditional causes like Bankart lesions are often considered.

Purpose of the Study:

• To investigate the etiology of recurrent shoulder instability in patients over 40.
• To evaluate the efficacy of surgical repair for specific rotator cuff and capsular tears.
• To determine if ligamentolabral complex integrity is essential for stability in this demographic.

Main Methods:

• Retrospective review of twelve patients with recurrent shoulder instability onset after age 40.
• Clinical assessment of injury patterns, focusing on anterior and posterior instability.
• Surgical intervention involving reattachment of ruptured subscapularis, anterior capsule, infraspinatus, teres minor, and posterior capsule to the tuberosities.

Main Results:

• Eleven patients presented with anterior instability, one with posterior dislocation.
• All anterior instability cases involved subscapularis and anterior capsule rupture from the lesser tuberosity.
• The posterior dislocation involved infraspinatus and teres minor rupture with the posterior capsule from the greater tuberosity.
• No Bankart lesions were identified in any patient.
• Surgical repair successfully restored stability in all twelve patients.
• One patient required reoperation; follow-up ranged from 2 to 13 years.

Conclusions:

• Recurrent shoulder instability in older adults can result from rotator cuff and capsular avulsions without significant ligamentolabral injury.
• Surgical repair of these specific tendon and capsular ruptures is sufficient to achieve shoulder stability.
• This finding challenges the necessity of addressing the ligamentolabral complex in all cases of recurrent shoulder instability in this age group.