C HA P T E R 8
Arthroscopic Repair of Posterior
Shoulder Instability
Posterior instability is relatively uncommon compared
with anterior instability of the shoulder. Most authors
agree that posterior shoulder instability represents approx-
imately 2% to 10% of shoulder instability cases.4,8,13 Initial
attempts to clarify the distinctions of posterior instability
were made in 1962, when McLaughlin recognized that
differences exist between “fixed and recurrent subluxations
of the shoulder,” suggesting that the etiology and treat-
ment of the two are distinctly different.15 More than 20
years later, in the early 1980s, Hawkins8 reviewed the dif-
ference between true dislocations and subluxations and
noted that true recurrent posterior dislocations are rare
compared with subluxation episodes. Since that time,
additional knowledge has been gained in the differences
between unidirectional and multidirectional, traumatic
and atraumatic, acute and chronic, and voluntary and
involuntary posterior instability. In many respects, each of
these may represent a distinct form of posterior instability
with its own underlying predispositions, anatomic abnor-
malities, and treatment algorithms.16,18 Our collective
understanding of posterior shoulder instability continues
to evolve.
Pathoanatomy
Recent advances in our understanding of the spectrum of
posterior instability have been gained through the study
of shoulder injuries in athletes, patients with generalized
ligamentous laxity, and patients with post-traumatic inju-
ries. Acute posterior dislocations typically result from a
ch008-X3447.indd 65
Steven B. Cohen, MD
James P. Bradley, MD
direct blow to the anterior shoulder or indirect forces that
couple shoulder flexion, internal rotation, and adduction.4,8
The most common indirect causes are accidental electric
shock and convulsive seizures. Because of incomplete
radiographic studies and a failure to recognize the poste-
rior shoulder prominence and mechanical block to exter-
nal rotation, 60% to 80% of locked posterior dislocations
are missed on initial presentation. Additional pathologic
processes are frequently associated with posterior instabil-
ity and include the reverse Hill-Sachs lesion, the reverse
bony Bankart lesion, posterior capsular laxity, excessive
humeral head retroversion or chondrolabral retroversion,
and glenoid hypoplasia.
Preoperative Considerations
History
To diagnose posterior instability, the clinician must
perform a thorough history and physical examination as
well as maintain a high index of suspicion. A history of a
posterior dislocation requiring formal reduction is more
obvious; however, patients with recurrent posterior sub-
luxation may present with more subtle findings. The
majority of patients with recurrent posterior subluxation
complain primarily of pain with specific activities, par-
ticularly in the provocative position (90-degree forward
flexion, adduction, and internal rotation),4,8 more so than
of instability.
65
10/17/2007 3:57:30 PM
 Surgical Techniques for Shoulder Instability

Physical Examination Magnetic Resonance Arthrography

● Evaluate labrum, capsule, biceps tendon, subscapularis
● Active and passive range of motion integrity (Fig. 8-5)
● Palpation for tenderness
Computed Tomography
● Strength testing
● Evaluate for glenoid version, locked dislocation
● Evaluation for impingement (Fig. 8-6)
● Assessment for generalized ligamentous laxity

Stability Testing Indications and Contraindications

● Load and shift test for anterior and posterior

translation (Fig. 8-1) Many patients with recurrent posterior subluxation can be
● Sulcus sign (in both neutral and external rotation) for managed successfully without surgery. Numerous authors
inferior translation have proposed a period of no less than 6 months of physi-
● Sulcus sign graded as 3+ that remains 2+ in external
cal therapy before surgical treatment is considered. Effec-
rotation is pathognomonic for multidirectional
instability

Specific Tests
● Jerk test (Fig. 8-2)

● Kim test (Fig. 8-3)

● Circumduction test

Imaging

Plain Radiographs
● Including axillary view

● Evaluate for reverse Hill-Sachs lesions (Fig. 8-4),

glenoid pathologic changes (retroversion, fractures,

and hypoplasia), bony humeral avulsion of the
glenohumeral ligaments
A

Figure 8-1 The load and shift test is performed by placing the thumb and
index or long finger around the humeral head, which is then shifted anteriorly
and posteriorly.
B
Figure 8-2 The jerk test for posterior instability. A, The arm is forward flexed
and internally rotated. B, Posteriorly directed force subluxes the shoulder.
Slow abduction of the arm results in a palpable jerk as the joint is reduced.
This test has also been described in reverse, by moving the arm from an
abducted position forward.

66

ch008-X3447.indd 66 10/17/2007 3:57:33 PM


B
Figure 8-3 The Kim test for the detection of posteroinferior labral lesions is
performed by applying axial compression to the 90-degree abducted arm (A),
which is then elevated and forward flexed in a diagonal direction (B),
resulting in pain and a possible clunk.
Figure 8-4 A reverse (anterior) Hill-Sachs lesion as demonstrated on an
axillary radiograph.
ch008-X3447.indd 67
Arthroscopic Repair of Posterior Shoulder Instability
Figure 8-5 Axial magnetic resonance scan through the glenohumeral joint
obtained with the intra-articular administration of contrast material
demonstrating a capacious posterior capsule.
Figure 8-6 Axial computed tomographic scan demonstrating a locked
posterior dislocation with large reverse Hill-Sachs lesion and destruction of a
significant portion of the articular surface.
tive rehabilitation includes avoidance of aggravating
activities, restoration of a full range of motion, and shoul-
der strengthening. Strengthening of the rotator cuff, pos-
terior deltoid, and periscapular musculature is critical. The
premise of such directed physical therapy is to enable the
dynamic muscle stabilizers to offset the deficient static
capsulolabral restraints. Nearly 70% of patients will im-
prove after an appropriate rehabilitation protocol. The
recurrent subluxation, however, is generally not elimi-
nated, but the functional disability is diminished enough
that it does not prevent activities. If the disability fails to
improve with an extended 6-month period of directed
67
10/17/2007 3:57:35 PM
 Surgical Techniques for Shoulder Instability

rehabilitation, or in select cases of posterior instability
resulting from a macrotraumatic event, surgical interven-
tion should be considered.
Indications
● Patients with continued disabling, isolated, recurrent
posterior subluxation after a rehabilitation program
● Recurrent posterior subluxation with a posterior labral
tear
● Multidirectional instability with a primary posterior
glenoid. A sulcus sign test is performed with the arm
adducted and in neutral rotation to assess whether the
instability has an inferior component. A 3+ sulcus sign
that remains 2+ or greater in external rotation is con-
sidered pathognomonic for multidirectional instability.
Testing is completed on both the affected and unaffected
shoulders, and differences between the two are
documented.

component
Patient Positioning, Landmarks,
and Portals
● Voluntary positional posterior instability

Relative indications include patients with an ante-
cedent macrotraumatic injury.
Contraindications
● Patients not having completed a reasonable
rehabilitation program
● A surgeon’s preference for traditional open techniques
● A large engaging reverse Hill-Sachs lesion requiring
subscapularis transfer or an osteochondral allograft
● A large reverse bony Bankart lesion
● Patients with voluntary muscle instability
● Underlying psychogenic disorders, and patients unable
or unwilling to comply with postoperative limitations
Relative contraindications may include chronic
instability resulting in compromised capsulolabral tissue
and patients who have undergone previous open surgery.
Because successful results have been achieved after
arthroscopic treatment of posterior labral tears in contact
athletes, arthroscopic reconstruction is not contraindi-
cated in that population.
The patient is then placed in the lateral decubitus position
with the affected shoulder positioned superior. An inflat-
able beanbag and kidney rests hold the patient in position.
Foam cushions are placed to protect the peroneal nerve at
the neck of the fibula on the down leg. An axillary roll is
placed. The operating table is placed in a slight reverse-
Trendelenburg position. The full upper extremity is pre-
pared to the level of the sternum anteriorly and the medial
border of the scapula posteriorly. The operative shoulder
is placed in 10 pounds of traction and positioned in 45
degrees of abduction and 20 degrees of forward flexion.
The bone landmarks, including the acromion, distal clavi-
cle, and coracoid process, are demarcated with a marking
pen.
After preparation and draping, the glenohumeral
joint is injected with 50 mL of sterile saline through an
18-gauge spinal needle to inflate the joint. A posterior
portal is established 1 cm distal and 1 cm lateral to the
standard posterior portal to allow access to the rim of the
glenoid for anchor placement (Fig. 8-7). An anterior portal

Surgical Technique
Anesthesia

The procedure can be performed under interscalene block

or general endotracheal anesthesia with an interscalene
block for postoperative pain control.

Examination Under Anesthesia

The examination under anesthesia is performed on a firm

surface with the scapula relatively fixed and the humeral
head free to rotate. A load-and-shift maneuver, as described
by Murrell and Warren, is performed with the patient
supine.12 The arm is held in 90 degrees of abduction and
neutral rotation while a posterior force is applied in an
Figure 8-7 Accessory posterior portal for anchor placement.
attempt to translate the humeral head over the posterior

68

ch008-X3447.indd 68 10/17/2007 3:57:37 PM

 Arthroscopic Repair of Posterior Shoulder Instability

is then established high in the rotator interval by an inside- ● An arthroscopic rasp or chisel is used to mobilize the
to-outside technique with a switching stick. Alternatively, torn labrum from the glenoid rim (Fig. 8-9).
it can also be established by an outside-to-inside technique ● A motorized synovial shaver or meniscal rasp is used
with the assistance of a spinal needle. Typically, only ante- to abrade the capsule adjacent to the labral tear and to
rior and posterior portals are required to perform the pro- débride and decorticate the glenoid rim to achieve a
cedure. An accessory 7-o’clock portal has been described bleeding surface.
but is not frequently used in our technique.
2. Placement of Suture Anchors
● Suture anchors are then placed at the articular margin
Diagnostic Arthroscopy of the glenoid rim, rather than down on the glenoid
neck, to perform the labral repair (Fig. 8-10).
A diagnostic arthroscopy of the glenohumeral joint is then 8
undertaken. The labrum, capsule, biceps tendon, subscap-
ularis, rotator interval, rotator cuff, and articular surfaces
are visualized in systematic fashion. This ensures that no
associated lesions will be overlooked by poorly directed
tunnel vision. Lesions typically seen in posterior instability
include a patulous posterior capsule, posterior labral tear,
labral fraying and splitting, widening of the rotator inter-
val, and undersurface partial-thickness rotator cuff tears.
After the glenohumeral joint is viewed from the posterior
portal, the arthroscope is switched to the anterior portal
to allow improved visualization of the posterior capsule
and labrum. A switching stick can then be used in replac-
ing the posterior cannula with an 8.25-mm distally
threaded clear cannula (Arthrex, Inc., Naples, Fla), thus
allowing passage of an arthroscopic probe and other
instruments through the clear cannula to explore the pos-
terior labrum for evidence of tears.

Specific Steps (Box 8-1) Figure 8-8 Posterior labral tear as viewed through the standard posterior
viewing portal; the probe is placed through the accessory posterior portal.

1. Preparation for Repair

When the posterior labrum is detached, suture anchors
are employed in performing the repair. The posterior
labrum is visualized from both the posterior and anterior
portals to appreciate the full extent of the tear (Fig. 8-8).
● The arthroscope then remains in the anterior portal,
and the posterior portal serves as the working portal
for the repair.

Box 8-1 Surgical Steps

1. Preparation for repair

2. Placement of suture anchors

3. Labral repair

4. Posterior capsular shift

5. Arthroscopic knot tying

6. Completion of the repair

7. Rotator interval closure Figure 8-9 Mobilization of the labrum with a rasp.

69

ch008-X3447.indd 69 10/17/2007 3:57:39 PM

 Surgical Techniques for Shoulder Instability

Figure 8-11 A suture-passing device penetrating the labrum.

Figure 8-10 Arthroscopic anchor placement on the glenoid rim.

● A posterior labral tear extending from 6-o’clock to 9-

o’clock on a right shoulder is typically repaired with
suture anchors at the 6:30, 7:30, and 8:30 positions.
● We prefer the 3.0-mm Bio-Suture Tak suture anchor
with No. 2 FiberWire (Arthrex, Inc., Naples, Fla)
because of the ease of placing the anchor on the
glenoid surface, but a number of other commercially
available anchors are also adequate.
● The suture anchor is placed with the sutures oriented
perpendicular to the glenoid rim to facilitate passage
of the most posterior suture through the torn labrum.
● Avoid inadvertent injury to the articular cartilage.

3. Labral Repair
● After placement of the suture anchors, a 45-degree
Spectrum suture hook (Linvatec, Largo, Fla) is loaded
with a No. 0 polydioxanone (PDS) suture (Ethicon,
Inc., Somerville, NJ). The contralateral side hook is
chosen (i.e., a left 45-degree hook for a right shoulder
when it is introduced from the posterior portal).
Alternatively, there are other commercially available
suture passers and suture relays that will also suffice.
● The suture passer is delivered through the torn labrum
and advanced superiorly, reentering the joint at the
edge of the glenoid articular cartilage (Fig. 8-11).
● Tension must be restored into the posterior band of
the inferior glenohumeral ligament to re-establish
posterior stability.
● Patients with acute injuries and less evidence of
capsular stretching do not require the same degree of
capsular advancement as do those with more chronic
instability.
Figure 8-12 Capsular plication (pleat stitch, capsulorrhaphy stitch) can be
performed to address capsular redundancy.
● In the setting of a labral tear with some capsular
laxity, the suture passer is advanced through the
posterior capsule approximately 1 cm lateral to the
edge of the labral tear and then underneath the labral
tear, to the edge of the articular cartilage, the so-called
pleat stitch (Fig. 8-12).
● Placement of as many pleat stitches as necessary in a
patulous shoulder capsule can reduce capsular
redundancy.
● The PDS suture is then fed into the glenohumeral
joint, and the suture passer is withdrawn through the
posterior clear cannula.

70

ch008-X3447.indd 70 10/17/2007 3:57:42 PM

 Arthroscopic Repair of Posterior Shoulder Instability

● An arthroscopic suture grasper is used to withdraw
both the most posterior suture in the suture anchor
and the end of the PDS suture that has been advanced
through the torn labrum. This move detangles the
sutures in the cannula.
● The PDS suture is then fashioned into a single loop
and tightly tied over the end of the braided suture.
● The most lateral PDS suture, which has not been tied
to the braided suture, is then pulled through the clear
cannula (Fig. 8-13).
This advances the most posterior suture in the suture
●
arthroscopy (Fig. 8-15). An isolated posterior
capsulorrhaphy is performed.
● Suture capsulorrhaphies are placed from inferior (6-
o’clock) to superior (10-o’clock).
● The 6:30 capsular suture is typically advanced to the
7:30 position, and the reduction in capsular volume is
assessed.
● Restoration of adequate tension in the posterior band
of the inferior glenohumeral ligament is critical.

anchor behind the labral tear (Fig. 8-14).

8
● A labral tear at the 7-o’clock position is advanced to
the 7:30 suture anchor, and the 8-o’clock labral tear
position is advanced to the 8:30 suture anchor.
Additional sutures are then placed in similar fashion
to complete the labral repair.
● If the capsule requires further tension, suture
capsulorrhaphies can be performed in the intervals
between the suture anchors directly to the newly
secured labrum.
● Knots are tied after the passage of each suture, which
allows continued assessment of the repair and the
degree of the capsular shift achieved by each suture

4. Posterior Capsular Shift

● The majority of patients with unidirectional posterior

instability and primary posterior multidirectional

instability do not have a posterior labral tear and
typically display significant capsular laxity at Figure 8-14 Sutures passed through the labrum, before tying.

Figure 8-13 Shuttling of the anchor suture through the labrum. Figure 8-15 Capacious posterior capsule as a sign of posterior instability.

71

ch008-X3447.indd 71 10/17/2007 3:57:44 PM

 Surgical Techniques for Shoulder Instability
● Additional sutures are then placed at the 7:30, 8:30,
and 9:30 positions on the capsule, advancing to
the 8:30, 9:30, and 10:30 positions on the glenoid
(Fig. 8-16).
● Sutures are tied after each is passed. If the sutures are
not tied until the end, one errant suture may
necessitate removal of all other sutures to achieve
correction.
5. Arthroscopic Knot Tying
● We prefer the sliding-locking Weston knot, but there
are a number of arthroscopic knot-tying techniques
that work well.
● What is most important is that the surgeon be
familiar with the knot used and be skilled in its use.
● The posterior braided suture exiting through the
capsule is threaded through a knot pusher, and the
end is secured with a hemostat.
● This suture serves as the post, which in effect will
advance the capsule and labrum to the glenoid rim
when the knot is tightened.
● The knot should be secured posteriorly on the capsule
and not on the rim of the glenoid to prevent humeral
head abrasion from the knot.
● Each half-hitch must be completely seated before the
next half-hitch is thrown.
● Placing tension on the non-post suture and advancing
the knot pusher “past point” will lock the Weston
knot.
● A total of three alternating half-hitches are placed to
secure the Weston knot.
Figure 8-16 Final appearance after capsular advancement.
72
ch008-X3447.indd 72
6. Completion of the Repair
● An arthroscopic awl is employed to penetrate the bare
area of the humerus, under the infraspinatus tendon,
in an effort to achieve some punctate bleeding to
augment the healing response.
● The posterior capsular portal incision is then closed by
passage of a PDS suture through the crescent
Spectrum suture passer and retrieval of the suture
with an arthroscopic penetrator.
● Varying the distance of the suture from the portal
incision allows titration of the capsulorrhaphy.
● The PDS suture is then tied blindly in the cannula,
closing the posterior capsular incision (Fig. 8-17)
7. Rotator Interval Closure
● In the setting of multidirectional instability with a
primary posterior component, the rotator interval
requires closure (defined by a 2+ or greater sulcus sign
that does not improve in external rotation).
● The rotator interval is viewed with the arthroscope in
the posterior portal.
● A crescent suture passer is advanced from the anterior
portal through the anterior capsule just above the
superior border of the subscapularis tendon 1 cm
lateral to the glenoid.
● It is then passed through the middle glenohumeral
ligament at the inferior border of the rotator interval.
This makes up the inferior aspect of the rotator
interval closure.
● A No. 0 PDS suture is then fed into the joint and
retrieved with a penetrator through the superior
glenohumeral ligament.
Figure 8-17 Closed posterior portal after cannula removal (as viewed from
anteriorly).
10/17/2007 3:57:49 PM

● The PDS suture is then withdrawn out the anterior
cannula, and the knot is tied blindly in the cannula
as the closure is visualized through the posterior
portal.
Postoperative Considerations
Rehabilitation and Return to
Play Recommendations
The rehabilitation program consists of a series of phases.
Initially, the posterior capsule must be protected by avoid-
ing extremes of internal rotation.
● Immobilization is maintained in an UltraSling
(DonJoy, Carlsbad, Calif ) for 6 weeks, abducting the
shoulder approximately 30 degrees.
● Immobilization is removed for gentle passive pain-free
range-of-motion exercises. We allow 90 degrees
forward flexion and external rotation to 0 degrees by
4 weeks after surgery.
● The UltraSling is discontinued 6 weeks after surgery.
Active-assisted range-of-motion exercises and gentle
passive range-of-motion exercises are progressed, and
pain-free gentle internal rotation is instituted.
● At 2 to 3 months after surgery, range of motion and
mobilization are progressed to achieve full passive and
active motion. Stretching exercises for the anterior and
posterior capsule are instituted.
● By 4 months after surgery, the shoulder should be
pain free. Concentration on eccentric rotator cuff
strengthening is begun.
● At 5 months after surgery, isotonic and isokinetic
exercises are advanced.
● At 6 months after surgery, throwing athletes undergo
isokinetic testing. When patients are able to achieve at
least 80% strength and endurance compared with the
uninvolved side, an integrated throwing protocol is
instituted.
PEARLS AND PITFALLS
● There is open debate about whether the lateral decubitus or beach
chair position better facilitates shoulder arthroscopy. We prefer the
lateral position because we think it allows better access to both the
anterior and posterior aspects of the shoulder. Placement of the
shoulder in 10 pounds of traction in the position of 45 degrees of
abduction and 20 degrees of forward flexion in effect displaces the
humeral head anteriorly and inferiorly, bringing the posterior labrum into
clear view. We have not been able to achieve such an unimpeded
approach to the posteroinferior shoulder capsule in the beach chair
position without imparting injury to the articular cartilage of the
humeral head in the process.
ch008-X3447.indd 73
Arthroscopic Repair of Posterior Shoulder Instability
● Throwers begin an easy-tossing program at a distance
of 20 feet without a wind-up. Stretching and the
application of heat to increase circulation before
throwing sessions are critical.
● By 7 months, light throwing with an easy wind-up to
30 feet is allowed 2 or 3 days per week for 10 minutes
per session.
● By 9 months after surgery, long, easy throws from the
mid-outfield (150 to 200 feet) are allowed.
● By 10 months, stronger throws from the outfield are
allowed, reaching home plate on only one or two
bounces. 8
● At 11 months, pitchers are allowed to throw one-half
to three-quarter speed from the mound with emphasis
on technique and accuracy.
● By 12 months after surgery, throwers are allowed to
throw from their position at three-quarter to full
speed. When the throwing athlete is able to perform
full-speed throwing for 2 consecutive weeks, return to
full competition is permitted.
● Nonthrowing athletes and nonathletes are managed
by criteria different from those for the throwing
athletes. When patients are able to achieve at
least 80% strength and endurance at the 6-month
isokinetic testing compared with the uninvolved
side, nonthrowing athletes begin a sport-specific
program.
● In general, power athletes and contact athletes, such as
weightlifters and football players, can return to full
competition by 6 to 9 months after surgery.
Noncontact athletes such as golfers, basketball players,
swimmers, and cheerleaders can generally return to
full competition by 6 to 8 months.
Complications
The complications include general risks of surgery, such as
infection and hematoma formation, as well as risks par-
ticular to arthroscopic posterior shoulder stabilization,
such as recurrent instability and stiffness.
● We prefer to inject the glenohumeral joint with 40 to 50 mL of
sterile saline before placement of the cannula into the glenohumeral
joint. It inflates the joint to allow safer insertion of the cannula,
limiting risk to the articular cartilage of the humeral head and
glenoid.
● After a determination of posterior labral disease or capsular laxity is
made, a posterior working portal must be established. Placement of an
8.25-mm distally threaded clear cannula over a switching stick into the
posterior portal will allow passage of both the crescent and 45-degree
suture hooks. Smaller cannulas will not accommodate the 45-degree
suture hook. We also recommend the use of suture anchors for
capsulolabral reconstruction instead of suture capsulorrhaphy alone as
it results in a more stable repair.
73
10/17/2007 3:57:53 PM
 Surgical Techniques for Shoulder Instability

PEARLS AND PITFALLS—cont’d
● Difficulty in the placement of suture anchors can be encountered if the
posterior portal is too far superior or medial in the posterior capsule.
The conventional posterior portal is near 10-o’clock on the right
glenoid, which makes approach to the posteroinferior glenoid difficult
for the placement of suture anchors. We therefore place the posterior
portal approximately 1 cm inferior and 1 cm lateral to the standard
posterior portal in patients with demonstrable posterior instability on
examination under anesthesia. When the posterior portal has been
made too far superior, an auxiliary posterior portal can then be made
inferior and lateral to the existing posterior portal. A spinal needle can
be used in positioning the auxiliary portal at 7-o’clock on the glenoid
and approximately 1 cm lateral to the glenoid rim on the posterior
capsule for approach to the posteroinferior glenoid at a 30- to 45-
degree angle in the sagittal plane. Cadaveric studies by Davidson and
Rivenburgh5 have shown the 7-o’clock portal to be a safe distance from
the axillary nerve and posterior humeral circumflex artery (39 ± 4 mm)
and the suprascapular nerve and artery (29 ± 3 mm). The use of blunt
trocars in the placement of the portal further decreases the risk of
neurovascular injury.
● We do not routinely close the rotator interval in patients with
unidirectional posterior instability. This practice is supported by several
other studies in the literature.13 Harryman et al7 sectioned the rotator
interval and found that in a position of 60 degrees flexion and 60
degrees abduction, a significant increase in posterior translation
occurred. However, in posterior instability’s provocative position of 60
degrees flexion and 90 degrees internal rotation, no significant increase
in posterior translation occurred after sectioning of the rotator interval.
Furthermore, although imbrication of the rotator interval significantly
decreased posterior translation at a position of 60 degrees flexion
and 60 degrees abduction, it did not have a similar effect in the
provocative position. A sectioned rotator interval did lead to a
significant increase in inferior translation, which was corrected by
imbrication of the rotator interval tissue. We do, however, perform
rotator interval closure in patients with an inferior component to their
instability, as defined by a 2+ or greater sulcus sign that does not
improve in external rotation.

Table 8-1 Summary of Studies of Arthroscopic Posterior Shoulder Instability Repair

Author Follow-up Outcome

13
Papendick and Savoie (1995) 10 months 39 of 41 (95%) successful

McIntyre et al11 (1997) 31 months 15 of 20 (75%) successful

15
Savoie and Field (1997) 34 months 55 of 61 (90%) successful

Wolf and Eakin18 (1998) 33 months 12 of 14 (86%) successful

10
Mair et al (1998) 2-year minimum 9 of 9 (100%) successful

Antoniou et al1 (2000) 28 months 35 of 41 (85%) successful

17
Williams et al (2003) 5.1 years 24 of 26 (92%) successful

Kim et al9 (2003) 39 months 26 of 27 (96%) successful

6
Fluhme et al (2004) 34 months 15 of 18 (83%) successful

Bottoni et al2 (2005) 40 months 16 of 18 (88%) successful

14
Provencher et al (2005) 39 months 26 of 33 (79%) successful

Bradley et al3 (2006) 27 months 91 of 100 (91%) successful

Results
Results of studies of arthroscopic repair of posterior
shoulder instability are presented in Table 8-1.

References

1. Antoniou J, Duckworth DT, Harryman DT II. Capsulolabral aug-
mentation for the management of posteroinferior instability of the
shoulder. J Bone Joint Surg Am 2000;82:1220-1230.
2. Bottoni CR, Franks BR, Moore JH, et al. Operative stabilization of
posterior shoulder instability. Am J Sports Med 2005;33:996-1002.
3. Bradley JP, Baker CL, Kline AJ, et al. Arthroscopic capsulolabral
reconstruction for posterior instability of the shoulder: a prospective
study of 100 shoulders. Am J Sports Med 2006;34:1061-1071.
4. Burkhead WZ Jr, Rockwood CA Jr. Treatment of instability of the
shoulder with an exercise program. J Bone Joint Surg Am
1992;74:890-896.
5. Davidson PA, Rivenburgh DW. The 7-o’clock posteroinferior
portal for shoulder arthroscopy. Am J Sports Med 2002;30:693-
696.
6. Fluhme DJ, Bradley JP, Burke CJ, et al. Open versus arthroscopic
treatment for posterior glenohumeral instability. Presented at the

74

ch008-X3447.indd 74 10/17/2007 3:57:53 PM


American Orthopaedic Society for Sports Medicine annual meeting;
Quebec City, Canada; June 24-27, 2004.
7. Harryman DT, Sidles JA, Harris SL, et al. The role of the rotator
interval capsule in passive motion and stability of the shoulder. J
Bone Joint Surg Am 1992;74:53-66.
8. Hawkins RJ, Koppert G, Johnston G. Recurrent posterior instability
(subluxation) of the shoulder. J Bone Joint Surg Am 1984;66:169.
9. Kim SH, Ha KI, Park JH, et al. Arthroscopic posterior labral repair and
capsular shift for traumatic unidirectional recurrent posterior sublux-
ation of the shoulder. J Bone Joint Surg Am 2003;85:1479-1487.
10. Mair SD, Zarzour RH, Speer KP. Posterior labral injury in contact
athletes. Am J Sports Med 1998;26:753-758.
11. McIntyre LF, Caspari RB, Savoie FH III. The arthroscopic treatment
of posterior shoulder instability: two-year results of a multiple suture
technique. Arthroscopy 1997;13:426-432.
12. Murrell GA, Warren RF. The surgical treatment of posterior shoul-
der instability. Clin Sports Med 1995;14(4):903–915.
ch008-X3447.indd 75
Arthroscopic Repair of Posterior Shoulder Instability
13. Papendick LW, Savoie FH III. Anatomy-specific repair techniques
for posterior shoulder instability. J South Orthop Assoc 1995;
4:169-176.
14. Provencher MT, Bell SJ, Menzel KA, Mologne TS. Arthroscopic
treatment of posterior instability: results in 33 patients. Am J Sports
Med 2005;33:1463-1471.
15. Savoie FH III, Field LD. Arthroscopic management of posterior
shoulder instability. Oper Tech Sports Med 1997;5:226-232.
16. Tibone JE, Bradley JP. The treatment of posterior subluxation in
athletes. Clin Orthop 1993;291:124-137.
17. Williams RJ III, Strickland S, Cohen M, et al. Arthroscopic repair
for traumatic posterior shoulder instability. Am J Sports Med
2003;31:203-209.
18. Wolf EM, Eakin CL. Arthroscopic capsular plication for posterior
shoulder instability. Arthroscopy 1998;14:153-163.
8
75
10/17/2007 3:57:53 PM