Anteromedial capsular redundancy and labral deficiency in shoulder instability.

Overview

BACKGROUND: Redundancy of the anteromedial capsule of the shoulder may persist despite proper tensioning of the capsule and repair of a Bankart lesion during an anteroinferior capsular shift procedure. HYPOTHESIS: A barrel-stitch suture technique incorporated into a capsular shift procedure is effective in achieving satisfactory shoulder stability. STUDY DESIGN: Uncontrolled retrospective review. METHODS: A barrel-stitch technique was used for patients identified as having anteromedial capsular redundancy during a capsular shift procedure for anteroinferior instability. RESULTS: The incidence of anteromedial capsular redundancy and labral deficiency was 49% (38 of 78). Patients with anteromedial capsular redundancy had a significantly greater number of dislocations before surgery (16.1 +/- 21.3 versus 7.4 +/- 7.4) and a greater duration of symptoms (79.8 +/- 84.2 versus 31.6 +/- 32.2 months). The mean postoperative Rowe score of patients with anteromedial capsular redundancy was 88.7 +/- 14.8, with 92% having excellent or good results, compared with 88.9 +/- 14.8 in the remaining patients and 93% excellent or good results. CONCLUSIONS: Anteromedial capsular redundancy is associated with longer preoperative duration of symptoms and more dislocations, but effective treatment can be achieved with a capsular shift procedure augmented with medial capsular imbrication with a barrel stitch.