You are here

Posterior Stabilization (Arthroscopic) 29806

synonyms: posterior labral repair, capsular plication

Arthroscopic Posterior Stabilization Indications

Arthroscopic Posterior Stabilization Contraindications

  • Voluntary, habitual instability due to psychological problems.
  • Excessive glenoid retroversion (consider glenoid opening wedge osteotomy)
  • Posterior glenoid bone loss (uncommon)
  • >25% Humeral head loss (reverse Hills-Sachs lesion)
  • Connective tissue disorders: Ehlers-Danlos, Marfan syndrome)

Arthroscopic Posterior Stabilization Alternatives

Arthroscopic Posterior Stabilization Pre-op Planning / Special Considerations

  • Ensure there is not a glenoid or humeral head lesion requiring bone graft or OATS.
  • Ensure adequate suture anchors (3.0mm or smaller anchors) and suture passing device (Spectrumor similar) are available.
  • Ensure any suture anchors are placed at the appropriate depth to avoid iatrogenic accelerated osteoarthritis, i.e. high anchors destory the humeral head articular cartilage.
  • Shoulder Arthroscopy case card.

Arthroscopic Posterior Stabilization Technique

  • Sign operative site
  • Pre-operative antibiotics, +/- regional block
  • General endotracheal anesthesia
  • Lateral position. All bony prominences well padded.
  • Examination under anesthesia.
  • Perform shoulder arthroscopy. Evaluate for reverse Hill-Sachs, posterior labral avulsion, reverse HAGL, Kim lesion, capsular tears, SLAP lesions, widened rotator interval, anterior labral tear.
  • Generally use additional posterior portal inferior and lateral to the working posterior portal. Posterior work is done while viewing from the anterior portal.
  • If posterior labrum is avulsed: Release posterior labroligamentous structures from the posterior glenoid and freshen the glenoid neck with a bur. Place anchors as indicated, pass sutures and tie. Consider added posterior capsular plication.
  • If posterior labrum is intact: Perform posterior capsular plication. Roughen capsule with abrader or rasp. Use curved suture hook (left hook for right shoulder) to plicate capsule from 6 o'clock to 9 or 10 o'clock position.\
  • rHAGL lesions: are repaired with anchors placed into the humeral head.

Arthroscopic Posterior Stabilization Complications

  • Recurrent instability
  • Inability to return to competitive sports
  • Persistent pain
  • Infection
  • Stiffness
  • CRPS
  • Nerve injury: Axillary nerve, suprascapular nerve.
  • Fluid Extravasation:
  • Chondrolysis: though to be related to heat from electo cautery or radiofrequency probes used during capsular release or capsular shrinkage.
  • Hematoma
  • Chondral Injury / arthritis

Arthroscopic Posterior Stabilization Follow-up care

  • Post-op: Place in shoulder immobilizer in slight abduction, slight extension and slight external rotation. Avoid flexion and internal rotation to protect repair. Perform elbow, wrist, hand ROM/strengthening,
  • 7-10 Days: Wound check, continue immobilization,
  • 6 Weeks: Discontinue immobilizer; begin cross-body adduction and light progressive resistive exercises / PT.
  • 3 Months: Begin sport specific training.
  • 4 Months: May return to non-contact sports.
  • 6 Months: May return to contact/collision sports.
  • Shoulder arthroscopy Rehab Protocol.

Arthroscopic Posterior Stabilization Outcomes

Arthroscopic Posterior Stabilization Review References

 

 

 

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer