Dataset Information

Open Shoulder Stabilization for Instability: Anterior Labral Repair With Capsular Shift.

ABSTRACT: Although anterior shoulder instability is most commonly treated with arthroscopic fixation, open labral repair with capsular shift may be best for select patients and in cases of revision stabilization without significant bone loss. The technique described in this article uses the deltopectoral interval; it involves careful dissection of the subscapularis from the anterior capsule, repair of the Bankart lesion, and a lateral and superior capsular shift using all-suture anchors in the humeral head. Advantages of this technique include meticulous control of anchor placement and the ability to provide additional stability via a lateral and superiorly directed capsular shift. This operation can be performed in a reliable, efficient, and reproducible manner.

SUBMITTER: Carlson Strother CR

PROVIDER: S-EPMC6714345 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Open Shoulder Stabilization for Instability: Anterior Labral Repair With Capsular Shift.

Carlson Strother Courtney R CR McLaughlin Richard J RJ Krych Aaron J AJ Sanchez-Sotelo Joaquin J Camp Christopher L CL

Arthroscopy techniques 20190704 7

Although anterior shoulder instability is most commonly treated with arthroscopic fixation, open labral repair with capsular shift may be best for select patients and in cases of revision stabilization without significant bone loss. The technique described in this article uses the deltopectoral interval; it involves careful dissection of the subscapularis from the anterior capsule, repair of the Bankart lesion, and a lateral and superior capsular shift using all-suture anchors in the humeral hea ...[more]

PMID: 31485402

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Project description:Posterior instability, although an uncommon shoulder pathology, is reported most frequently in the athletic population. Arthroscopic repair has emerged as the main surgical treatment modality for posterior instability. However, when compared with arthroscopic repair for anterior instability, the results of this procedure remain suboptimal. The creation of iatrogenic defects in the capsule, due to cannula placement, is a possible culprit. Because these defects typically do not heal satisfactorily, they become stress risers within the capsule itself, which may lead to recurrent instability or an otherwise compromised repair construct. Therefore, we find that routine intraoperative repair of these defects after repair can reduce the risk of injury and possibly improve long-term outcomes. In this article, we illustrate the repair of a posterior segmental tear using all-suture knotless implants with closure of the posterior and posterior-inferior portals after stabilization. Technique Video Video 1 Arthroscopic repair of segmental posterior labral tear with portal closure. The patient is in the lateral decubitus position. Both 30° and 70° arthroscopes are used throughout the procedure. The observed segmental labral tear pattern is somewhat similar to a bucket-handle tear, beginning roughly at the 5:30 clock-face position and propagating to the 2-o’clock position. The labral fragment is preserved and incorporated into the repair. After glenoid preparation, knotless all-suture anchors (Arthrex) are placed starting posterior-inferiorly and continuing superiorly. The sutures are only partially tensioned until placement is complete. Final tensioning occurs from the inferior-to-superior direction. Concomitant capsulorrhaphy is also performed with the labral repair. After the repair, closure of the posterior portals is performed because open portals can potentially contribute to postoperative capsular laxity, as well as act as stress risers within the capsule. The accessory posterior-inferior portal is closed first by passing a suture through the portal’s adjacent capsule and tying in a blinded manner just outside the capsule. Finally, the standard posterior portal is closed using analogous steps.

Project description:PurposeTo determine whether range of motion (ROM) varies with the location and extent of labral tear seen in patients undergoing arthroscopic anterior shoulder stabilization.MethodsConsecutive patients undergoing arthroscopic anterior shoulder stabilization who were enrolled in the Multicenter Orthopaedic Outcomes Network Shoulder Instability database underwent a preoperative physical examination and intraoperative examination under anesthesia in which ROM was recorded. Intraoperatively, the location and extent of the labral tear was recorded using conventional clock-face coordinates. Patients were grouped by combinations of quadrants involved in the labral tear (G1-G7): G1 = anterior only, G2 = anterior + inferior, G3 = anterior + inferior + posterior, G4 = all quadrants, G5 = superior + anterior, G6 = superior + anterior + inferior, and G7 = posterior + superior + anterior. Statistical analyses were performed with the Kruskal-Wallis rank-sum test. When P < .05, a post-hoc Dunn's test was performed. For categorical variables, the χ2 test was performed. We performed a series of bivariate negative binomial regression models testing pairwise combinations of ROM parameters predicting the count of labral tear locations (possible: 0-5) within each quadrant.ResultsA total of 467 patients were included, with 13 (2.8%) in G1, 221 (47.3%) in G2, 40 (8.6%) in G3, 51 (10.9%) in G4, 18 (3.9%) in G5, 121 (25.9%) in G6, and 3 (0.6%) in G7. Multiple statistically significant differences were noted in ROM, specifically active internal rotation at side (IRS) (P = .005), active abduction (P = .02), passive IRS (P = .02), and passive external rotation in abduction (P = .0007). Regression modeling revealed a positive correlation between passive abduction and predicted count of labral tear locations in the superior quadrant and between passive IRS and predicted count of labral tear location in the inferior quadrant.ConclusionsIn patients undergoing arthroscopic shoulder stabilization for anterior instability, ROM varies with location and extent of labral tear. However, the clinical relevance of such small ROM differences remains undetermined.Level of evidenceII, prospective comparative study.

Dataset Information

Open Shoulder Stabilization for Instability: Anterior Labral Repair With Capsular Shift.

Publications

Open Shoulder Stabilization for Instability: Anterior Labral Repair With Capsular Shift.

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