History of surgical stabilization for posterior shoulder instability

Abstract

Background: Posterior shoulder instability is common in young athletes. Although the posterior shoulder instability literature is less robust than its anterior counterpart, many surgical procedures have been developed and refined over the past several centuries to address this condition.

Materials and methods: This article represents a retrospective historical analysis of the most common procedures used to treat posterior shoulder instability after sports injuries. A systematic approach to obtain published information on posterior shoulder instability was performed using the PubMed/MEDLINE database, manual searches of high-impact factor journals, and conference proceedings and books.

Results: A wide array of both soft tissue-based and bone-based procedures have been developed for the treatment of posterior shoulder instability, ranging from procedures addressing the soft tissue alone (capsular shift, labral repair, reverse Putti-Platt) or bone-based procedures (glenoid and/or humeral osteotomy, glenoid bone block) to a combination of both bone and soft-tissue procedures (modified McLaughlin procedure).

Discussion: Over the past several centuries, a number of procedures have been developed to address posterior shoulder instability, particularly as this pathology has become better understood. Future work is required not only to continue to advance these procedures but also to assess their outcomes. An understanding of the historical perspective of posterior shoulder instability procedures is essential as surgeons continue to modify these procedures in an effort to best help their patients.

Keywords: Posterior glenohumeral instability; arthroscopic; dislocation; history of surgery; shoulder; shoulder stabilization; stabilization; subluxation.

Figure 1

Drawing of glenoid (G) bone block (BB) (taken from acromion or iliac crest).

Figure 2

Drawing of modified McLaughlin procedure: transfer of subscapularis (SS) and/or lesser tuberosity (LT) to McLaughlin lesion (ML). G, glenoid.

Figure 3

Drawing of posterior-inferior capsular shift. The dashed line represents the initial incision into the deltoid (removed here for illustrative purposes) along a posterolateral raphe. The incision is limited to less than 5.0 centimeters to prevent damage to the underlying axillary nerve. The arrow is demonstrating the superior shift of the posteroinferior flap of the capsule in order to remove the inferior pouch and reinforce the repair. The capsule was initially split in a T-shaped fashion in the mid-glenoid region, which created two capsular flaps. The superior flap was shifted inferiorly and reattached to the lateral aspect of the humeral neck. A, acromion; HH, humeral head; PC, posterior-inferior capsule.

Figure 4

Arthroscopic posterior-inferior labral repair for posterior shoulder instability using 2 bioabsorbable knotless suture anchors and tape.