Summary

Arthroscopic labral reconstruction with a modified inferior capsular shift for anterior shoulder dislocation at average 13-year follow-up yields a low failure rate, no evidence of glenohumeral joint narrowing, and a high rate of return to sports without risk or increased recurrence.

Abstract

Background

Treatment for the dislocated shoulder is fraught with controversy across the globe. Recurrence rates of anterior shoulder instability are highest in young, high risk athletes. The purpose of this study was to evaluate patient activity level and function following arthroscopic labral reconstruction with a modified inferior capsular shift by a single surgeon at a mean 13-year follow-up comparing patients greater than 25 years of age to patients less than 25 years old.

Methods

Between 1999 and 2010, 56 patients with a documented anterior dislocation underwent an arthroscopic labral reconstruction with a modified inferior capsular shift and met the inclusion criteria. The technique utilized included a minimum of 3 anterior suture anchors placed below the equator along with sutures placed to perform a glenoid-based inferior capsular shift with or without a rotator interval closure depending on the size of the Hill Sachs lesion. Patients completed the ASES, MISS, WOSI, DASH, Rowe, Constant, and VR-12 patient-reported outcomes scores at final follow-up. Patients were asked to score their satisfaction with the outcome of their surgery on a scale of 1 (unsatisfied) to 10 (very satisfied). A sense of apprehension or a subluxation event was categorized as a failure and a dislocation event was categorized as a reinjury. Plain radiographs were independently reviewed for glenohumeral joint space decrease from preoperative films. The presence of OA, failure, and loss of motion were recorded in both groups. Patients were divided into 2 groups by age (<25 years old vs =25 years old) for analysis.

Results

There were 26 patients in the younger, high risk group (<25 years) and 28 patients in the older patient group (=25 years of age). The younger group were all males that participated in moderate to vigorous sports as categorized by American College of Sports Medicine, and 88% had traumatic dislocation prior to surgery. There were 2 (3.7%) failures requiring revision surgery and 3 (5.6%) reinjuries requiring surgery. All revisions were in male patients, who participated in high-risk sports (baseball, hockey, sailing). At mean 13-year follow-up, all patients in the younger, high risk age group and the older age group returned to sport activities. All patients in the younger, high risk group returned and only 71% (21/28) of patients the older group returned to sport activities at an equal level as prior to injury (p=0.014). No evidence of glenohumeral narrowing was noted on plain radiographs. No differences were seen in outcome scores between the cohorts at follow-up.

Conclusion

We report excellent results in both young, high risk and older patients following arthroscopic labral reconstruction with a modified capsular shift at mean 13-year follow-up. The addition of glenoid-based arthroscopic labral reconstruction with a modified inferior capsular shift resulted in low failure rate, high return to sport rate with no loss of motion, and no evidence on plain radiographs of narrowing of the glenohumeral joint.