Arthroscopic Rotator Interval Closure by Purse String Suture for Symptomatic Inferior Shoulder Instability

Abstract

Multidirectional instability of the shoulder is a complex condition that can be difficult to diagnose and treat. Clinically, it is characterized by symptomatic global laxity of the glenohumeral joint and may present either traumatically or atraumatically, unilaterally or bilaterally, and with or without generalized joint laxity. Capsular plication is a primary treatment option in these patients and is used to tension the redundant or lax capsule. We evaluated the role of rotator interval closure in restoring stability as a primary procedure in patients with multidirectional instability and a positive and painful sulcus sign.Twenty adult patients (16 men and 4 women) presenting with multidirectional instability were evaluated clinically and radiologically to assess the degree and direction of instability, were treated by arthroscopic rotator interval closure and inferior capsular plication, and were followed up for a minimum of 2 years. Clinical and functional results were excellent at 2-year follow-up. The results of the study indicate that the closure of the rotator interval in patients with symptomatic inferior instability will have a long-lasting effect on the stability and function of the shoulder, as the closure improves not only the static restraints but also the dynamic restraints of the shoulder through the improved proprioception secondary to restoration of the rotator interval structures.