[Arthroscopic posterior shoulder stabilization with an iliac bone graft and capsular repair].

OBJECTIVE: Arthroscopic posterior shoulder stabilization with an iliac bone graft and capsulolabral repair, which should combine the pre-existing open procedure with the advantages of improved arthroscopic visualization. INDICATIONS: Posterior instability with concomitant pathologies (e.g. capsular insufficiency, posterior Bankart lesion, posterior glenoid dysplasia) and recurrent posterior instability after failed soft tissue reconstruction. CONTRAINDICATIONS: Instability osteoarthritis, locked posterior shoulder dislocation, large reverse Hill-Sachs lesion, extended posterior defect of the glenoid. SURGICAL TECHNIQUE: After arthroscopic evaluation of the shoulder joint and treatment of concomitant pathologies, a tricortical bone graft is harvested from the iliac crest. The posterior capsule is arthroscopically detached from the labrum and the posterior deltoid and rotator cuff are split in line of the muscle fibers. Then the bone graft is positioned and fixed to the posterior scapular neck as an extension of the articular glenoid surface. Thereafter, capsular reconstruction is performed after insertion of suture anchors in the posterior glenoid rim. POSTOPERATIVE MANAGEMENT: During the first 6 weeks 60° of abduction and flexion are permitted without any rotation and full range of motion is developed gradually. Internal rotation is allowed after 8 weeks and return to sports after 12 weeks.
RESULTS: For posterior shoulder instability 13 of these operations were performed in our hospital since 2011. Until now, no recurrent instability was observed. After remodelling of the graft, one patient complained about posterior soft tissue irritation so the screws were removed.