[Recurrent anterior and multidirectional instability of the shoulder]

Surgical treatment for recurrent anterior instability associated to multidirectional shoulder hyperlaxity: results analysis.

Twenty five patients operated for recurrent anterior dislocation or subluxation with multidirectional hyperlaxity. Age at operation was low (22 years old), there were more females than males, instability was bilateral in 52 per cent cases.

Five patients underwent a capsular shift followed by a four weeks post operative immobilization. Twenty patients underwent a bone block procedure with the coracoid process associated with a modified capsular shift. Inferior half of the subscapularis muscle was left intact under the coraco-biceps tendon.

The results were fair with only 52 per cent excellent or good results. Ten patients (40 per cent) presented a recurrence either a dislocation or a subluxation. Hyperlaxity recurred in all but three patients. The procedure didn't influence the results which were related to the antecedent: the patients with a previous history of voluntary recurrent posterior subluxations achieved 33 per cent fair or poor results. Patients with previous history of recurrent anterior subluxation achieved 100 per cent poor results, whereas the patients without antecedent achieved 85 per cent good to excellent results.

Establishing a difference between laxity and instability helps to analyse the patients with an unstable shoulder rather than considering traumatic or atraumatic onset of the instability. Identification of the hyperlaxity and of the antecedents must influence the therapeutic discussion.

We recommend to use the term multidirectional hyperlaxity rather than multidirectional instability to characterize these patients.