Arthroscopic Rotator Interval Closure by Purse String Suture for Symptomatic Inferior Shoulder Instability

Abstract

Multidirectional instability of the shoulder is a complex condition that can be difficult to diagnose and treat. Clinically, it is characterized by symptomatic global laxity of the glenohumeral joint and may present either traumatically or atraumatically, unilaterally or bilaterally, and with or without generalized joint laxity. Capsular plication is a primary treatment option in these patients and is used to tension the redundant or lax capsule. We evaluated the role of rotator interval closure in restoring stability as a primary procedure in patients with multidirectional instability and a positive and painful sulcus sign.Twenty adult patients (16 men and 4 women) presenting with multidirectional instability were evaluated clinically and radiologically to assess the degree and direction of instability, were treated by arthroscopic rotator interval closure and inferior capsular plication, and were followed up for a minimum of 2 years. Clinical and functional results were excellent at 2-year follow-up. The results of the study indicate that the closure of the rotator interval in patients with symptomatic inferior instability will have a long-lasting effect on the stability and function of the shoulder, as the closure improves not only the static restraints but also the dynamic restraints of the shoulder through the improved proprioception secondary to restoration of the rotator interval structures.

The “Purse-string” Technique for Shoulder Stabilization, Description of the Technique, Long term Results and Literature Review

“…Finally, in case of failure the fact that only one anchor has been inserted makes revision simpler leaving space for revision anchors to be inserted [8]. The “purse- string” suture can also be used in the very complex group of patients with multidirectional instability after careful selection and knowledge of the technique can lead to successful results in this difficult to treat condition [16]. …”

“…This technique has been used to improve symptoms in multidirectional instability patients with more prominent antero- inferior instability symptoms. In 20 patients, at 2 years follow up, symptoms significantly improved and no re-dislocations were recorded [16]. …”

Atraumatic shoulder instability: pathophysiology clinical assessment and practical management

“…Post surgical studies on athletes have reported both positive [66,67] as well as unsatisfactory [68] results on successful return to sporting activities at the top or pre-injury levels. The RI closure also leads to an improvement in both the static and the dynamic restraints which enhances the effect on the shoulder stability and function [69] . Despite the universal adoption of the arthroscopic practice, open procedures have shown good outcomes with an acceptable failure rate [70,71,72] .…”

Peer Review #1 of "Achilles and tail tendons of perlecan exon 3 null heparan sulphate deficient mice display surprising improvement in tendon tensile properties and altered collagen fibril organisation compared to C57BL/6 wild type mice (v0.1)"

“…This is a painful condition, which increases in severity if left untreated. Treatment options include surgical intervention, physiotherapy with specific strengthening exercises for muscle groups to better hold the shoulder in proper position, cortisone injections and anti-inflammatory medications (Bigliani et al 1996;Moon et al 2011). GAG (E) and Hydroxyproline (F) content of 3 to 12 week-old WT and Hspg2 ∆3-/∆3tail tendons.…”