A modified capsular shift for atraumatic anterior-inferior shoulder instability

Abstract

Purpose: To evaluate the long-term outcome of a modified inferior capsular shift procedure in patients with atraumatic anterior-inferior shoulder instability by analyzing a consecutive series of patients who had undergone a modified inferior capsular shift for this specific type of shoulder instability.

Study design: Case series; Level of evidence, 4.

Methods: Between 1992 and 1997, 38 shoulders of 35 patients with atraumatic anterior-inferior shoulder instability that were unresponsive to nonoperative management were operated on using a modified capsular shift procedure with longitudinal incision of the capsule medially and a bony fixation of the inferior flap to the glenoid and labrum in the 1 o'clock to 3 o'clock position. The patient study group consisted of 9 men and 26 women with a mean age of 25.4 years (range, 15-55 years) at the time of surgery. The mean follow-up was 7.4 years (range, 4.0-11.4 years); 1 patient was lost to follow-up directly after surgery. The study group was evaluated according to the Rowe score.

Results: After 7.4 years, 2 patients experienced a single redislocation or resubluxation, 1 patient had recurrent dislocations, and 1 patient had a positive apprehension sign, which is an overall redislocation rate of 10.5%. The average Rowe score increased to 90.6 (SD = 19.7) points from 36.2 (SD = 13.5) points before surgery. Seventy-two percent of the patients participating in sports returned to their preoperative level of competition.

Conclusions: Results in this series demonstrate the efficacy and durability of a modified capsular shift procedure for the treatment of atraumatic anterior-inferior shoulder instability.