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Scientific Articles   |    
Arthroscopic Capsulolabral Revision Repair for Recurrent Anterior Shoulder Instability
Christoph Bartl, MD1; Andreas B. Imhoff, MD2
1 Department of Orthopaedic Trauma Surgery, University of Ulm, Steinhoevelstrasse 9, 89075 Ulm, Germany. E-mail address: christoph.bartl@uniklinik-ulm.de
2 Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaningerstrasse 22, 81675 Munich, Germany. E-mail address: a.imhoff@sportortho.de
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The line drawings in this article are the work of Joanne Haderer Müller of Haderer & Müller (biomedart@haderermuller.com).

Based on an original article: Am J Sports Med. 2011 Mar;39(3):511-8. Epub 2011 Jan 6.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2012 Jan 25;02(01):e2 1-13. doi: 10.2106/JBJS.ST.K.00023
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Extract

Overview
Introduction

Arthroscopic capsulolabral reconstruction via the anteroinferior 5:30 portal allows secure placement of the suture anchors in the lower half of the glenoid and adequate retensioning of the inferior glenohumeral ligament.

Step 1: Examination Under Anesthesia

With the patient under anesthesia, and prior to surgical intervention, assess the direction of glenohumeral instability and the presence of joint hyperlaxity to confirm the repair strategy preoperatively and to determine if additional procedures such as rotator interval closure or inferior capsular plications are needed.

Step 2: Arthroscopic Evaluation and Portal Placement

Underestimating the anteroinferior bone loss is one of the most common failures of arthroscopic capsulolabral revision repairs.

Step 3: Mobilization of Capsulolabral Complex

Mobilize the capsulolabral complex down to the 6:00 position with a bent rasp to create a bleeding surface for biological healing.

Step 4: Anchor Placement

Place anchors at 5:30, 4:30, and 3:00, with additional anchors in the inferior half of the glenoid if more capsular material has to be shifted.

Step 5: Capsulolabral Shift and Knot Tying

A sufficient capsular shift of the anterior band of the inferior glenohumeral ligament at the lowest fixation point (5:30 anchor) is a key step of the procedure.

Step 6: Additional Tissue Reconstruction

Consider performing a rotator interval closure in patients with joint hyperlaxity or if a residual “drive through” sign with inferior instability remains after retensioning of the capsulolabral structures.

Step 7: Rehabilitation

Start with passive exercises and increase to active-assisted and active exercises.

Results

In our study of fifty-six patients treated with arthroscopic capsulolabral revision repair for recurrent anterior shoulder instability, arthroscopic evaluation at the revision repair showed glenoid bone loss measuring up to 10% of the inferior glenoid width due to compression fracture of the glenoid rim in almost 50% of the cases and glenoid bone loss measuring 10% to 20% in about 20% of the cases.

What to Watch For

Indications

Contraindications

Pitfalls & Challenges

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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