Labrum repair combined with arthroscopic reduction of capsular volume in shoulder instability

Abstract

We performed arthroscopic treatment of traumatic anterior and anteroinferior shoulder instability combining three procedures-labrum repair, reduction of capsular volume and suture of the rotator cuff intervalwith the aim of analysing the results with regard to stability and function. Between January 1999 and December 2003, 27 patients underwent arthroscopic treatment for labrum repair with metal anchors, reduction of capsular volume through thermal capsulorrhaphy and suture of rotator cuff interval. These patients were evaluated in the pre-and postoperative period using the UCLA and Rowe scales and in the postoperative period using the ASES scale. During a mean follow-up period of 32.4 months (range 22-74 months) all shoulders remained stable. Using the UCLA scale, there was improvement from the preoperative period, with a mean score of 24.7, to the postoperative period, with a mean of 32.81. Improvement was also shown by the Rowe scale, with a mean score of 39.81 in the preoperative period and 90.74 in the postoperative period. On the ASES scale the mean score was 92.22. All shoulders remained stable and there was marked functional improvement in the patients who were treated. These results are comparable to those obtained with open surgery, observing similar patient selection criteria.

Effect of arthroscopic techniques on joint volume in shoulder instability: Bankart repair versus capsular shift

“…To our best knowledge there has been no report on volume reduction effect in the clinical in vivo scenario in arthroscopic stabilization techniques apart from our technical report on arthroscopic capsular shift [22]. Such evaluation would provide proper knowledge of how the surgical techniques affect the joint biomechanics and the anatomy of the glenohumeral joint [12][13][14][15][16][17][18][19][20][21].…”

“…Capsular shift is intended to decrease volume, thus constraining the joint. The potential to reduce the joint volume has been studied before on a cadaveric shoulder model [12][13][14][15][16][17][18][19][20][21], showing that open techniques allow for higher volume reduction (40-50 %) than arthroscopic techniques (30-40 %). However, a cadaveric shoulder may not reflect a life scenario of the unstable shoulder in a much younger population and different joint capacity despite the fact that various modifications of arthroscopic techniques have been published to make either capsular shift or plication.…”

Arthroscopic rotator interval closure in shoulder instability repair: A retrospective study

“…Several methods that have been described for the closure of the RI differed mainly in the method of suture passing. 1,3,4,6,10,11,18 Previous arthroscopic RI closures resulted in good stability and improvement in functional status, 12 and seemed to have improved the outcome of shoulder instability repair, with up to 97% stability rates at a minimum of 2 years of follow-up. 17 Rotator interval closure alone was proven effective in the treatment of patients with an exclusive (no PBL) RI defect (27.5 mm)-associated inferior and multidirectional shoulder instability.…”

“…Only few small clinical trials had demonstrated good shoulder stability after open and arthroscopic closure of the RI. 5,12,17 We performed a retrospective study to compare the results of arthroscopic anterior shoulder instability repair with and without closure of the RI.…”

Blood supply and vascularity of the glenoid labrum: Its clinical implications

“…Several studies [3][4][5][6][7][8][9][10][11] have reported a significant correlation between labral fixation and glenohumeral translation. In contrast, Kim et al 12 reported an insignificant correlation between the extent of the labral lesion and the frequency of glenohumeral dislocation.…”