Retrospective Analysis of Arthroscopic L-type Inferior Capsular Shift for Treatment of Anterior Shoulder Instability

Abstract

Background: Shoulder instability or its recurrent form is a common complaint in daily orthopedic practice. Many treatment approaches are in use. However, continuous advancements are introduced to increase safety and effectiveness. The current work aimed to assess the arthroscopic management of anterior shoulder instability and dislocation by L-Type arthroscopic capsular shift.

Patients and Methods: This was a retrospective multicenter study. It included 70 patients with unilateral should instability unidirectional recurrent dislocation. Preoperative evaluation included (history, clinical and radiological examinations). Then, local examination was directed to discover muscle wasting, deformity, local tenderness and stability tests. The radiological workup included plain radiography, MRI and MR arthrography. Postoperatively, shoulder was immobilized for 6 weeks.  The overall results were scored by University of California, Los Angeles (UCLA) score (including domains of pain, functions, active forward flexion & its strength, satisfaction and total score).

Results: The right shoulder was the commonly affected side (78.6%). Playing sports on regular basis was reported for (15.7%). X-ray showed normal findings for 71.4%, humeral head defect in 22.9% and Bankart lesions in 5.7%. Arthroscopic examination revealed isolated capsular laxity for 62.9%, laxity with labral tears for 18.6% and laxity with rudimentary labrum among 12.9%. The postoperative pain was minimal or absent in 95.7%, moderate in 2.9% and severe in 1.4%. All subjects returned to normal preoperative activities at the final follow-up visit, with no or minimal limitations recorded for (97.1%) and moderate limitations for 2.9%. The only registered complication was recurrent instability in one patient (1.4%). UCLA assessment revealed a significant improvement in all its domains after than before surgery.

Conclusion: The Arthroscopic L-type Inferior Capsular Shift for treatment of anterior shoulder instability provides a safe and effective treatment approach. On a short-term follow-up, the recurrence rate is minimal with no or mild complications.