The arthroscopic treatment of posterior shoulder instability: two-year results of a multiple suture technique

This study was undertaken to review the results of an arthroscopic posterior capsular shift procedure. Twenty consecutive shoulders in 19 patients were treated with an arthroscopic posterior capsular shift for symptomatic posterior shoulder instability. Patients underwent the procedure if they exhibited a posterior Bankart lesion or had complaints of posterior instability and evidence of increased posterior joint laxity on physical examination and examination under anesthesia. Twelve of the 20 patients were injured during athletic activity. All surgeries were performed in an outpatient setting. Twelve of the 20 patients had posterior Bankart lesions and 10 had anterior Hill-Sachs lesions. The procedure entails releasing the posterior labroligamentous structures from the posterior glenoid and freshening the glenoid neck with a bur. A suture punch is used to place multiple absorbable monofilament stitches in the ligament complex. The stitches are brought through a supraclavicular portal and tied over the clavicle or scapular spine. All 20 shoulders were evaluated at an average of 31 months postoperatively with a minimum follow-up of 24 months. Based on the outcome scale described by Tibone and Bradley, the average postoperative score was 83 out of a possible 100, with 15 excellent, 2 good, 1 fair, and 3 poor results. There were two recurrent dislocations and three subluxations for an overall recurrence rate of 25%. All the recurrences occurred in patients with posterior Bankart lesions and four of the five had a voluntary component to their instability. There were no neurovascular complications or infections. Arthroscopic evaluation facilitated the diagnosis of posterior instability with the visualization of intra-articular pathology that is difficult to identify during open procedures. Although the majority of patients were able to return to vigorous activities, a recurrence rate of 25% is disturbing and consistent with recurrence rates for open procedures.