180˚ Posterior and Inferior Labral Tear in A Professional Collision Athlete with Symptomatic Posterior Shoulder Instability, A Case Report.

Abstract

Background: Posterior labral tears are common in the shoulders of collision athletes and frequently present with instability and dysfunction. These can be successfully stabilized arthroscopically, but it is essential to identify and treat the full extent of the injury, especially in high demand athletes. We present a surgical technique utilized to repair a 180˚ posterior and inferior labrum tear in a professional collision athlete with symptomatic posterior instability. Indications: Arthroscopic stabilization of posterior labral tears is indicated in athletes with recurrent instability events and the inability to return to their previous level of play with nonoperative management. Technique Description: This arthroscopic 180˚ posterior and inferior labral repair is performed in the lateral decubitus position. An EUA helps guide surgical management, as identifying and treating the full extent of the labral tear is essential for successful management. An accessory posteroinferior 7 o’clock portal is necessary for low posterior anchor placement. Stability is critical in collision athletes so slightly overtightening the shoulder is optimal, and large bites in the capsule allow for an aggressive capsular shift. Multiple suture tapes are utilized per anchor, increasing the number of fixation points in the capsule and labrum, creating a very robust repair. A large spread between sutures in the same anchor is avoided to prevent bunching of the labrum. Percutaneous anchors are placed to completely address superior and anterior extension. Results Arner, McClincy and Bradley have shown very successful outcomes following posterior labral repairs in American football players. 93% returned to play with 79% returning at the same level, and 96.5% were satisfied with the procedure. They showed these players can safely return to contact sports at 6 months following surgery. Our patient followed a similar course, returning to professional collision sports at 6 months post op and was very satisfied with his outcome. Discussion/Conclusions: Arthroscopic posterior labral repair can be a very successful procedure if the full extent of the labral tear is identified and addressed. Robust fixation and an aggressive capsular shift are the goals in collision athletes.