Anterior and anterior-inferior shoulder instability: Treatment by glenoid labrum reconstruction and a modified capsular shift procedure

An anterior glenoid labrum reconstruction in conjunction with a modified anterior-inferior capsular shift is described and was performed in 64 patients (69 shoulders) with traumatic anterior or anterior-inferior glenohumeral instability. Sixty-three operations were performed for recurrent dislocation and six for recurrent subluxation. The patients in this study were extremely active in sports, with the majority of Tegner ratings exceeding 7.0. Fifty-six patients with 61 operated shoulders were available for clinical follow-up at an average of 36 months (range 28 to 78 months). With rating scales from the American Shoulder and Elbow Surgeons, pain improved from an average of 3.1 to an average of 4.4, stability improved from 1.1 to 4.5, and function improved from 2.5 to 3.8. Postoperative average ranges of motion were 180° of forward elevation, 72° of external rotation with the arm at the side, 92° of external rotation with the arm at 90° of abduction, and 90° of internal rotation with the arm at 90° of abduction. Ninety-five percent of the patients were satisfied with the procedure. Five patients suffered a recurrent dislocation, four from significant trauma. One additional patient experienced an episode of subluxation early in the recovery period. According to the criteria of Rowe, 90% had excellent or good results.