1. Robert A. Arciero, MD (LTC. Ret.), University of Connecticut Health Center, Farmington, CT
2. Craig R. Bottoni, MD (LTC), Tripler Army Medical Center, Honnolulu, HI
3. Thomas M. DeBerardino, MD (LTC), Keller Army Hospital, West Point, NY
4. Dean C. Taylor, MD (Col.), Keller Army Community Hospital, West Point, NY

Objective:  To evaluate the results of operative treatment using open and arthroscopic techniques for athletes with recurrent, traumatic posterior subluxation of the shoulder. Hypothesis: Athletes with traumatic posterior shoulder subluxation have distinct pathologic lesions of the labrum, articular margin and capsule and operative repair addressing these lesions leads to satifactory outcomes and return to sport.

Methods:  From May 1996-November 2002, all patients with recurrent, traumatic posterior subluxation of the shoulder who underwent operative stabilization were evaluated. Preoperative radiographs, MRI, and arthroscopy was performed in each patient. Operative stabilization utilized two techniques: open posterior Bankart repair and arthroscopic posterior capsulolabral repair. Results were determined using the Rowe score, SANE score, Simple Shoulder test, and a validated outcomes instrument for stability, the Western Ontario Shoulder Instability score (WOSI- lower score is improved income, range 0-2100 points).

Results:  From May 1996-November 2002, 33 patients with 34 shoulders underwent operative stabilization for recurrent posterior shoulder subluxation.The average age was 23 years old with an average follow-up of 27 months (range: 14-63). The open technique was used in 11 shoulders and the arthroscopic method in 23 (suture anchor repair-17; bioabsorbable tacks- 6). All patients had lesions of the posterior capsulolabral complex (partial or complete detachment) and glenoid articular margin.

For the entire group the SANE score, Rowe, Simple Shoulder Test, and WOSI score was 87, 86, 11, and 364 respectively. For the open method the SANE score was 84, Rowe 83, Simple Shoulder Test 10.6, and WOSI score was 524. The arthroscopic method resulted a SANE score of 89, Rowe 90, Simple Shoulder Test 11.1, and WOSI score of 248. Althought it appeared that the arthroscopic method led to imporvbed outcomes, this was not statistically significant. Twenty-Eight of 34 shoulders were rated excellent or good.

Conclusions:  Recurrent, traumatic posterior shoulder subluxation frequently occurs with collision involving a posterior directed force on a forward flexed arm. Posterior lesions of the labrum ('reverse Bankart'), articular edge, and capsule are observed. Surgical treatment focusing on repair of these lesions led to satisfactory results. The arthroscopic method using suture anchors, nonabsorbable suture and capsular plication mirrors the technical features of the open method and may provide results equal or better than the open technique with reduced moribitidy. Further study is warranted.

References:  

1. Williams RJ, Strickland S, Cohen M, et al: Arthroscopic Repair for Traumatic Posterior Shoulder Instability. Am J Sports Med 2003 (31):203-209