Dong-Wook Kim1, Chong-Kwan Kim, Sung-Weon Jung. 1. Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 50 Hapsung 2-Dong, Changwon-si, Gyeongsangnam-do, Korea.
Abstract
PURPOSE: This study examined the clinical results of an arthroscopic simple pleated capsular shift to treat severe recurrent anterior dislocation of the shoulder. METHODS: Twenty-four patients with anterior labroligamentous periosteal sleeve avulsion or advanced lesions who underwent an arthroscopic simple pleated capsular shift were included in this study. To create an arthroscopic simple pleated capsular shift, redundant capsules, including glenohumeral ligaments, were brought at least 1 cm lateral and 1 cm inferior and shifted to the prepared glenoid. Four sutures were made at the 5, 4, 3, and 1-2 o'clock positions with four anchors. Clinical results were evaluated using a visual analog scale (VAS), ROWE scores, active motion, and return to activity. Statistical analyses were carried out using paired t tests. RESULTS: Three out of 24 patients had complaints. Two patients with recurrent instability underwent a repeat surgery, while the other patient complained of a stiff shoulder. There was a significant improvement in the VAS and ROWE scores post-operatively versus pre-operatively (p < 0.001, p < 0.001, respectively), but no significant differences in active motion except for external rotation, which decreased post-operatively (p = 0.02). CONCLUSIONS: In patients with severe recurrent anterior dislocation, simple pleated capsular shift provided a reliable result. Four capsular shift sutures, 1 cm lateral and 1 cm inferior from the glenoid, were sufficient to reduce shoulder joint volume and restore stability. The arthroscopic capsular shift could be an alternative method in the case of no available labral lesion for repair. LEVEL OF EVIDENCE: Case series, Therapeutic, Level IV.
PURPOSE: This study examined the clinical results of an arthroscopic simple pleated capsular shift to treat severe recurrent anterior dislocation of the shoulder. METHODS: Twenty-four patients with anterior labroligamentous periosteal sleeve avulsion or advanced lesions who underwent an arthroscopic simple pleated capsular shift were included in this study. To create an arthroscopic simple pleated capsular shift, redundant capsules, including glenohumeral ligaments, were brought at least 1 cm lateral and 1 cm inferior and shifted to the prepared glenoid. Four sutures were made at the 5, 4, 3, and 1-2 o'clock positions with four anchors. Clinical results were evaluated using a visual analog scale (VAS), ROWE scores, active motion, and return to activity. Statistical analyses were carried out using paired t tests. RESULTS: Three out of 24 patients had complaints. Two patients with recurrent instability underwent a repeat surgery, while the other patient complained of a stiff shoulder. There was a significant improvement in the VAS and ROWE scores post-operatively versus pre-operatively (p < 0.001, p < 0.001, respectively), but no significant differences in active motion except for external rotation, which decreased post-operatively (p = 0.02). CONCLUSIONS: In patients with severe recurrent anterior dislocation, simple pleated capsular shift provided a reliable result. Four capsular shift sutures, 1 cm lateral and 1 cm inferior from the glenoid, were sufficient to reduce shoulder joint volume and restore stability. The arthroscopic capsular shift could be an alternative method in the case of no available labral lesion for repair. LEVEL OF EVIDENCE: Case series, Therapeutic, Level IV.
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