Arthroscopic Repair of a Posterior Midcapsular Rupture Causing Posterior Shoulder Instability

Background: Gross posterior instability is rare and when found likely has an injury or deficiency to the posterior static restraints of shoulder associated with it. Traditionally, injuries to the posterior capsule have been difficult to diagnose and visualize with magnetic resonance imaging preopera...

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Autores principales:	Gautam P. Yagnik MD, Kevin West MD, Bhavya K. Sheth MD, Luis Vargas MD, John W. Uribe MD
Formato:	article
Lenguaje:	EN
Publicado:	SAGE Publishing 2021
Materias:	Sports medicine RC1200-1245 Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/c8ce99aab7c748829c2c065da8b21767
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spelling	oai:doaj.org-article:c8ce99aab7c748829c2c065da8b217672021-11-16T22:33:18ZArthroscopic Repair of a Posterior Midcapsular Rupture Causing Posterior Shoulder Instability2635-025410.1177/26350254211031921https://doaj.org/article/c8ce99aab7c748829c2c065da8b217672021-10-01T00:00:00Zhttps://doi.org/10.1177/26350254211031921https://doaj.org/toc/2635-0254Background: Gross posterior instability is rare and when found likely has an injury or deficiency to the posterior static restraints of shoulder associated with it. Traditionally, injuries to the posterior capsule have been difficult to diagnose and visualize with magnetic resonance imaging preoperatively, and very little literature regarding arthroscopic repair of posterior capsular tears exists currently. Indications: We present a repair of a posterior midcapsular and posterior labral tear in a 26-year-old man with recurrent left posterior shoulder instability using a novel all–arthroscopic technique. Technique Description: We performed a shoulder arthroscopy in a lateral decubitus position with the arm at 45° of abduction using standard posterior viewing and anterior working portals. Diagnostic arthroscopy revealed a large posterior midcapsular rupture approximately 2 cm lateral to the glenoid with an associated posterior labral tear. We created an accessory posterolateral portal with needle localization that was outside the capsular defect yet allowed access to the posterior labrum. Anatomic closure of the capsular tear was achieved arthroscopically with 3 interrupted No. 2 nonabsorbable sutures in a side–to–side fashion. Posterior labral repair and capsular shift were done to further address the instability using 2 knotless all–suture anchors percutaneously placed at the 7 o'clock and 9 o'clock position. We closed the posterior portal with a combination of curved and penetrating suture passers. Incisions were closed with interrupted 4-0 nylon. Postoperatively, the patient was placed in an ultra–sling for 4 weeks before physical therapy. We allowed light strengthening at 8 weeks, full strengthening at 12 weeks, and estimated return to sport at 4 months. Results: At 6 months postoperatively, the patient has regained symmetric motion, full strength, and has no residual pain or instability. Conclusion: Gross posterior instability is a rare and difficult condition to diagnose and manage. If no significant labral injuries are identified, injury to the posterior capsule must be considered and full assessment should be done when visualizing from the anterior portal. Repair of the posterior capsule is necessary and can be achieved all arthroscopically with this technique.Gautam P. Yagnik MDKevin West MDBhavya K. Sheth MDLuis Vargas MDJohn W. Uribe MDSAGE PublishingarticleSports medicineRC1200-1245Orthopedic surgeryRD701-811ENVideo Journal of Sports Medicine, Vol 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Sports medicine RC1200-1245 Orthopedic surgery RD701-811
spellingShingle	Sports medicine RC1200-1245 Orthopedic surgery RD701-811 Gautam P. Yagnik MD Kevin West MD Bhavya K. Sheth MD Luis Vargas MD John W. Uribe MD Arthroscopic Repair of a Posterior Midcapsular Rupture Causing Posterior Shoulder Instability
description	Background: Gross posterior instability is rare and when found likely has an injury or deficiency to the posterior static restraints of shoulder associated with it. Traditionally, injuries to the posterior capsule have been difficult to diagnose and visualize with magnetic resonance imaging preoperatively, and very little literature regarding arthroscopic repair of posterior capsular tears exists currently. Indications: We present a repair of a posterior midcapsular and posterior labral tear in a 26-year-old man with recurrent left posterior shoulder instability using a novel all–arthroscopic technique. Technique Description: We performed a shoulder arthroscopy in a lateral decubitus position with the arm at 45° of abduction using standard posterior viewing and anterior working portals. Diagnostic arthroscopy revealed a large posterior midcapsular rupture approximately 2 cm lateral to the glenoid with an associated posterior labral tear. We created an accessory posterolateral portal with needle localization that was outside the capsular defect yet allowed access to the posterior labrum. Anatomic closure of the capsular tear was achieved arthroscopically with 3 interrupted No. 2 nonabsorbable sutures in a side–to–side fashion. Posterior labral repair and capsular shift were done to further address the instability using 2 knotless all–suture anchors percutaneously placed at the 7 o'clock and 9 o'clock position. We closed the posterior portal with a combination of curved and penetrating suture passers. Incisions were closed with interrupted 4-0 nylon. Postoperatively, the patient was placed in an ultra–sling for 4 weeks before physical therapy. We allowed light strengthening at 8 weeks, full strengthening at 12 weeks, and estimated return to sport at 4 months. Results: At 6 months postoperatively, the patient has regained symmetric motion, full strength, and has no residual pain or instability. Conclusion: Gross posterior instability is a rare and difficult condition to diagnose and manage. If no significant labral injuries are identified, injury to the posterior capsule must be considered and full assessment should be done when visualizing from the anterior portal. Repair of the posterior capsule is necessary and can be achieved all arthroscopically with this technique.
format	article
author	Gautam P. Yagnik MD Kevin West MD Bhavya K. Sheth MD Luis Vargas MD John W. Uribe MD
author_facet	Gautam P. Yagnik MD Kevin West MD Bhavya K. Sheth MD Luis Vargas MD John W. Uribe MD
author_sort	Gautam P. Yagnik MD
title	Arthroscopic Repair of a Posterior Midcapsular Rupture Causing Posterior Shoulder Instability
title_short	Arthroscopic Repair of a Posterior Midcapsular Rupture Causing Posterior Shoulder Instability
title_full	Arthroscopic Repair of a Posterior Midcapsular Rupture Causing Posterior Shoulder Instability
title_fullStr	Arthroscopic Repair of a Posterior Midcapsular Rupture Causing Posterior Shoulder Instability
title_full_unstemmed	Arthroscopic Repair of a Posterior Midcapsular Rupture Causing Posterior Shoulder Instability
title_sort	arthroscopic repair of a posterior midcapsular rupture causing posterior shoulder instability
publisher	SAGE Publishing
publishDate	2021
url	https://doaj.org/article/c8ce99aab7c748829c2c065da8b21767
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Arthroscopic Repair of a Posterior Midcapsular Rupture Causing Posterior Shoulder Instability

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