Arthroscopic Capsulolabral Repair for Posterior Shoulder Instability with Suture Anchors Using a Beach Chair Approach

Abstract

Background: Posterior shoulder instability is a relatively rare cause of recurrent instability with its incidence at 2 to 10%. It is often associated with a posterior capsulolabral tear for which Arthroscopic repair has shown good outcome. In terms of approach, there is a lack of consensus among surgeons regarding the most optimal position to perform the Arthroscopy with earlier studies favoring the use of the Lateral Decubitus (LD) over the Beach Chair (BC) position. Aim: This study is a mini-case series describing a surgical technique using the BC position in Arthroscopic posterior capsulolabral reconstruction. The authors of this study hypothesize that the use of the BC position is adequate in Arthroscopic posterior capsulolabral reconstruction so long as the surgeon is cognizant of its limitations. Methods: A retrospective analysis of the prospectively collected data was performed for 9 shoulders with posterior capsulolabral injury in 8 patients. At a tertiary hospital, the patients underwent an Arthroscopic posterior capsulolabral reconstruction using the BC position by a fellowship trained shoulder Orthopaedic surgeon. Patients were assessed preoperatively and prospectively followed up for two years and at 2 years postoperatively for isometric strength, range of motion (ROM), and various outcome measures. These included the visual analogue scale (VAS), Oxford Shoulder Score (OSS), UCLA Shoulder Score (UCLASS), and Constant Shoulder Score (CSS) and for pain assessment. Results: All the patients were male with a mean age was 25.1 (Range 20-33). 4 out of 9 (44.4%) patients suffered from a traumatic event. The mechanism of injury varied among these patients. All patients had a posterior labral tear with 7 out of 9 having concomitant capsular laxity. There was significant improvement in UCLA scores (18.4 vs 29.8) (P=0.001), Oxford Shoulder Score (37.8 vs 16.1) (P<0.001) and VAS score (3.9 vs 1.3) (P=0.017) at 2 years postoperatively. There was no significant improvement in Isometric strength, Constant Shoulder Scores and Range of motion (Abduction and Forward flexion). Conclusion: The study hypothesized that the use of the BC position is adequate in posterior capsulolabral reconstruction so long as the surgeon is familiar and comfortable with the technique. Level of evidence: 2