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