Surgical Techniques

1.  Arthroscopic Posterior Bankart Repair +/- Capsular Plication

 

Posterior Labral TearPosteior Labral Repair

 

Technique

 

Posterior Portal

- make slightly inferior and lateral compare to normal

- inspect joint

- place anterior portal +/- ASL portal

 

Remove cameral and place thorough anterior portal

- place 8 mm cannula through posterior cameral portal (over switching stick)

 

Often need second portal lateral and inferior to place inferior anchor

- can use simple stab incision here

 

Assess labrum and capsule

- repair posterior bankart

- plicate redundant / patulous capsule

 

Results

 

Kim et al JBJS Am 2003

- 27 patients with unidirectional posterior instability

- all with labral injuries, most with capsular laxity

- all had arthroscopic posterior labral repair and capsular shift

- only one recurrence

 

Pennington Arthroscopy 2010

- 28 athletes with pure posterior labral pathology

- 93% return to sport

 

Bradley et al Am J Sports Med 2006

- 91 athletes with 100 shoulders with unilateral posterior instability

- variations of suture anchor labral repair / anchor capsulolabral repair / capsular plication sutures

- 30% posterior labral tear, 43% patulous capsule with no labral pathology

- remainder combination injuries including partial labral tears

- 8% failure rate, all with capsular laxity

- patients had evidence of chondrolabral retroversion

 

2.  Open Posterior Capsular shift 

 

Open Technique

 

Position

- lateral

 

Incision

- vertical incision

- posterior axillary fold

 

Shoulder Posterior Approach

 

Superficial dissection

- split deltoid to expose infraspintous

- elevate IS off capusle

- L shaped incision infraspinatous after tagging sutures medial

- T shaped capsulotomy of capsule for posterior shift (vertical limb on humeral insertion)

 

Dangers

- no more than 1.5cm medial to glenoid to protech SS nerve

- axillary nerve through quadrangular space below Tm

 

Procedure

- labral detachment reattached if present

- graft glenoid with bone from spine / iliac crest if defect

- inferior capsule shifted superiorly

- reinforced with superior limb of capsule

- may augment with IS tensioning

 

3. Posterior Glenoid Osteotomy

 

Reserved for in setting of severe posterior retroversion with instability

 

Posterior glenoid osteotomy