Arthroscopic Posterior Stabilization and Anterior Capsular Plication for Recurrent Posterior Glenohumeral Instability (SS-18)

Abstract

Posterior shoulder instability is less common than anterior shoulder instability and consists of a broad spectrum of clinical presentations and pathology. Recurrent, traumatic, involuntary, unidirectional posterior instability is the most common form. Arthroscopic techniques are currently employed as treatment for these patients. The purpose of this study is to evaluate the outcomes of arthroscopic posterior Bankart reconstruction with modern suture anchor repair in a well-defined patient population and to evaluate preoperative and operative factors as determinants of success. Thirty patients with an average age of 26.9 years (range 15.7-43.4) all had traumatic detachment of the posterior labrum and underwent suture anchor repair with posterior capsulolabral plication. Supplemental anterior capsulolabral plication and additional surgeries were performed as required. Patients were evaluated an at an average follow-up of 5.5 years (range 2.0-12.4 years) with shoulder outcomes scores including the American Shoulder and Elbow Surgeons (ASES) Rating Scale, the Western Ontario Shoulder Instability (WOSI) Index, the University of California at Los Angeles (UCLA) score and the Simple Shoulder Test (SST). Subjective patient evaluations for success, strength, range of motion, instability, pain and return to sport were also recorded. All patients had posterior Bankart lesions that required suture anchor repair. The average postoperative ASES score was 90.0 (range 53.3-100), UCLA score of 32.6 (range 24-35), SST of 11.7 (10-12), WOSI of 366 (0-1033) or 82.6% of normal (50.8-100%). Ninety-seven percent of patients (29/30) reported they were satisfied and better, 97% (29/30) reported a successful treatment and 97% (29/30) felt the surgery was worthwhile and would repeat it if necessary. Recurrent postoperative posterior instability occurred in 3.3% (1/30) of patients. Eighty-five percent of patients (23/27) returned back to sports with 69.2% (18/26) being able to return to the their previous level of athletics. Patients who required additional procedures at the time of surgery had worse postoperative ASES, WOSI, UCLA outcomes scores (p<0.0107) and higher subjective pain and instability scores (p<0.0428). Younger patients (<30 years old) reported lower subjective postoperative strength and higher instability scores (p<0.0347). Patients who received supplemental anterior plication capsulolabral sutures reported higher subjective pain scores (p<0.0315). This is the longest known follow-up reported for arthroscopic posterior shoulder instability surgery. Suture anchor stabilization of posterior Bankart lesions is an effective treatment for recurrent, traumatic, involuntary, unidirectional posterior shoulder instability. Younger patients and patients with more extensive pathology who require supplemental procedures may have slightly less reliable outcomes.