Arthroscopic therapy of recurrent anterior luxation of the shoulder by capsular repair.

Sixty-five cases of recurrent anterior unidirectional dislocation of the shoulder were treated by arthroscopic capsular repair. In this approach, the arthroscope is inserted through a posterior portal. Using mostly an anterior portal, a 5-mm hole is drilled across the neck of the glenoid, between the 3 and 4 o'clock positions. A 5-mm working cannula is passed from the posterior portal into the joint. Mostly through the anterior portal, four to six retention U-sutures are placed in the labrum, the middle and inferior glenohumeral ligament, and the subscapularis tendon. A 25-cm-long, 2.0-mm K-wire with an eye is used. The sutures are pulled out posteriorly through the cannula and tied on the fascia of the infraspinatus muscle. The goal of the procedure is to reattach the detached labrum-ligament complex (LLC) and achieve a capsulorrhaphy in a medial-lateral and superior-inferior direction. There were nine redislocations during a follow-up period of 24-60 months (average, 35.3 months). Reasons for redislocation were (a) fewer than four sutures; (b) no sutures of the LLC; (c) placement of the drill hole in the top third of the glenoid; (d) nontraumatic dislocation; (e) no Bankart or Hill-Sachs lesion; (f) transverse tear of the LLC; or (g) technical errors. Redislocation was more common in male patients.