Delta-Loop-Stitch: Three-Point Fixation for Combined Radial and Tangential Capsular Shift for the Treatment of Multidirectional Instability of the Shoulder and Hyperlaxity

Abstract

Multidirectional shoulder instability and hyperlaxity can be treated with arthroscopic shoulder stabilization and capsular shift. In these patients, the joint capsule often becomes the weak link in terms of pullout strength and cutting through of the used sutures, which can further be compromised by reduced quality of the capsular tissue. The described delta-loop-stitch combines a loop stitch through the capsule with a 3-point-fixation to the intact labrum thus distributing the load and reducing the risk of failure of the fixation. The suture knots are directed under the joint capsule away from the articulating surfaces to reduce the risk of iatrogenic lesions of the articular cartilage. The circumferential application of the delta-loop-stitch allows a sufficient capsular shift that combines a radial and tangential shift and reduction of the overall joint volume that can be adjusted to the patient's individual situation and the surgeon's preference.