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. 2023 May 5;11(5):23259671221146167.
doi: 10.1177/23259671221146167. eCollection 2023 May.

Arthroscopic Posterior Capsulolabral Repair With Suture-First Versus Anchor-First Technique in Patients With Posterior Shoulder Instability (Type B2): Clinical Midterm Follow-up

Katrin Karpinski  1 , Doruk Akgün  1 , Henry Gebauer  1 , Christian Festbaum  1 , Lucca Lacheta  1 , Kathi Thiele  1 , Philipp Moroder  2
Affiliations

Arthroscopic Posterior Capsulolabral Repair With Suture-First Versus Anchor-First Technique in Patients With Posterior Shoulder Instability (Type B2): Clinical Midterm Follow-up

Katrin Karpinski et al. Orthop J Sports Med. .

Abstract

Background: Isolated soft tissue injuries of the posterior capsulolabral complex can be addressed arthroscopically, with various anchor systems available for repair.

Purpose: To evaluate clinical and patient-reported outcomes after arthroscopic capsulolabral repair in patients with posterior shoulder instability (PSI) and to compare differences in outcomes between patients treated with a suture-first technique (PushLock anchor) and an anchor-first technique (FiberTak all-suture anchor).

Study design: Cohort study; Level of evidence, 3.

Methods: Included were 32 patients with dynamic structural PSI (type B2 according to the ABC classification) treated with an arthroscopic posterior capsulolabral repair. After a mean follow-up time of 4.8 ± 3.4 years (range, 2-11) patients were evaluated clinically, and standardized outcome scores were obtained for the Subjective Shoulder Value (SSV), the Western Ontario Shoulder Instability Index (WOSI), Rowe, Kerlan-Jobe Orthopaedic Clinic (KJOC), patient satisfaction (0-5 [best]), and pain on a visual analog scale (VAS; 0-10 [worst]).

Results: The overall satisfaction level with the outcome of the surgery was 4.6 ± 0.5 (range, 4-5). No patient suffered from instability events. The mean VAS level for pain was 0.4 ± 0.9 (range, 0-4) at rest and 1.9 ± 2.0 (range, 0-6) during motion. The mean SSV was 80 ± 17 (range, 30-100), the mean postoperative WOSI score 75% ± 19% (range, 18-98), the mean Rowe score 78 ± 20 (range, 10-100), and the mean KJOC score was 81 ± 18 (range, 40-100) for the entire cohort. There was no significant difference between the techniques with regard to range of motion, strength, or clinical outcome scores.

Conclusion: Arthroscopic posterior capsulolabral repair was a satisfactory method to treat structural PSI type B2 with regard to stability, pain relief, and functional restoration. The majority of patients had good outcomes. No differences in outcomes were observed between the anchor-first and suture-first techniques.

Keywords: ABC classification; anchor-first technique; posterior capsulolabral repair; posterior shoulder instability; suture-first technique.

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Conflict of interest statement

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Axial magnetic resonance arthrography image of a patient with B2 posterior shoulder instability with posterior labral damage (arrow).
Figure 2.
Figure 2.
ABC classification of posterior shoulder instability.
Figure 3.
Figure 3.
Flow diagram of patient enrollment ( a contact via telephone and email after anchor-first, 5 patients; after suture-first, 5 patients). OA, osteoarthritis. Surgical Technique and Rehabilitation
Figure 4.
Figure 4.
Capsulolabral repair with the suture-first technique. (A) After mobilizing the posterior capsulolabral complex, (B) a looped FiberWire was passed through the posterior capsulolabral complex with the help of a SutureLasso, and (C) the free ends were then pulled through the looped end to create a cinch stitch. (D) The cinch stitch was then fixed to the posterior glenoid rim using a PushLock anchor. The steps were repeated with as many anchors as needed for complete refixation.
Figure 5.
Figure 5.
Capsulolabral repair with the anchor-first technique. (A) Mobilization of posterior capsulolabral complex. (B) FiberTak all-suture anchor at the bony edge of the posterior glenoid rim. (C) Suture lasso used to pass both suture ends through the capsulolabral complex. (D) Knot tied to create a mattress stitch to reattach the labrum.
See this image and copyright information in PMC

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