Latarjet procedure combined with inferior capsular shift for recurrent anterior shoulder instability in patients with hyperlaxity

Abstract

Background Recurrent unidirectional anterior shoulder instability is a common disease especially among professional athletes. Open latarjet operation is a common surgical procedure used for the treatment of this condition, especially in cases associated with a high instability severity index score (ISIS) including cases with humeral bone loss (Hill–Sachs lesion) or anteroinferior glenoid bone loss. Persistent apprehension or recurrence of instability after the latarjet procedure might be attributed to associated anterior capsular laxity that was not addressed in the primary surgery. Hypothesis Combining coracoid bone transfer with capsulorraphy and capsular shift, and maintaining the sling effect of the conjoint tendon might be beneficial in patients with recurrent anterior shoulder instability associated with anterior capsular redundancy (ACR). Patients and methods A total of 30 patients with recurrent unilateral symptomatic involuntary unidirectional anterior shoulder instability were studied. All patients had an evidence of joint hyperlaxity with a Beighton score ranging from 6 to 9, mean 7.63±1.07. Evidence of ACR (Sulcus sign) was present. ISIS was superior than or equal to 4. In this study, the ISIS ranged from 6 to 10, with a mean of 8.38 and SD of 0.89. All of the patients underwent an open Latarjet procedure with superior capsular shift and capsulorraphy using Ethibond N:5 sutures wrapped around the serrations of the screw. All the patients were interrogated, examined clinically, and scored according to the Constant–Murley scoring system. Results The most important finding of this study is the marked improvement in the symptoms of instability as well as the level of function after surgery. There was a highly statistically significant difference between the preoperative and the postoperative Constant–Murley score. Conclusion In anterior shoulder instability with ACR, the Latarjet procedure associated with an anteroinferior capsulorrhaphy is an effective alternative to arthroscopic or open capsular shift and should help in reducing postoperative apprehension. The sooner the reconstructive surgery is performed, the better the functional outcome.