Arthroscopic Labral Reconstruction With a Modified Inferior Capsular Shift Allows Return to Sport and Excellent Outcomes in Contact and Noncontact Athletes With Anterior Shoulder Instability at Minimum 5-Year Follow-Up

Abstract

PurposeTo compare return to sport, functional outcomes, recurrence of instability, and osteoarthritis(OA) between collision/contact and limited/non-contact athletes following arthroscopic labral reconstruction with a modified inferior capsular shift for anterior shoulder instability. MethodsAthletes underwent an arthroscopic labral reconstruction with a modified inferior capsular shift, by the senior author between 1999 and 2017. Inclusion criteria were labral stripping from 12(just beyond the biceps anchor) to 6 o’clock, less than 20% glenoid bone loss, active sports participation, and no prior surgery. Athletes were divided into collision/contact and limited/non-contact groups. Outcome measures, physical examination, and radiographic evaluation were collected at a minimum 5-year follow-up. Re-operations or any subjective laxity were considered failures. Radiographs were analyzed for OA utilizing Samilson-Prieto Radiological Classification. ResultsNinety-two patients underwent arthroscopic labral reconstruction with a modified inferior capsular shift. Sixty-four met the inclusion criteria. Thirty-eight(age=26.0±8.0 years) participated in at least one collision/contact sport, and 26(age=38.0±9.0 years) participated in limited/non-contact sports. Two(5%) collision/contact and 3(12%) limited/non-contact athletes had traumatic re-injury requiring revision surgery. Of the remaining athletes (59/64), minimum 5-year follow-up was obtained on 54(92%) with a mean follow-up of 12±4 years(range 5 to 23 years). All athletes returned to their original sport at the same level. There was no significant difference between collision/contact and limited/non-contact athletes in timing of return to sports (5.2±1.9 and 6.0±3.1 months, respectively; p=0.389). There were no significant differences between groups on any outcomes scores. ConclusionArthroscopic labral reconstruction with a modified inferior capsular shift addressed anterior instability with return to sport for both collision/contact and limited/non-contact athletes with excellent functional and clinical outcomes, full shoulder ROM, and a low prevalence of advanced OA at minimum 5-year follow-up. This modified technique resulted in a low failure rate in both limited/non-contact and collision/contact athletes.