AOSSM 2022 Annual Meeting Recordings - no CME-Outcomes After Arthroscopic Pancapsular Shift for the Treatment of Multidirectional Glenohumeral Instability at a Mean 9 Year Follow-up

Outcomes After Arthroscopic Pancapsular Shift for the Treatment of Multidirectional Glenohumeral Instability at a Mean 9 Year Follow-up

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Video Summary

The video features a presentation on arthroscopic treatment of multidirectional instability (MDI) conducted during a fellowship at the Steadman Clinic. MDI refers to instability in more than two directions including inferior. Different types of MDI exist, and many patients have underlying hyperlaxity. Nonoperative management is the preferred treatment, but patients often continue to experience pain and instability. The open capsular shift was developed in the 1980s to address this, but arthroscopic treatment has become more popular due to fewer complications like decreased capsular volume and ability to treat circumferential pathology. Short-term studies show positive outcomes, but long-term results are needed. This study reviewed patients treated between 2005 and 2015, with a minimum of five-year follow-up. Results showed that 28% reported recurrent instability, 16% had a redislocation event, and 10% required further surgery. Patient-reported outcomes improved significantly, and the longevity of improvement was observed. Patients who reported recurrent instability but did not undergo revision surgery still experienced improvement, but slightly decreased compared to those with stable shoulders. The study redefined surgical success to include shoulder stability or feeling of instability with an acceptable patient-reported outcome score. Atraumatic and traumatic MDI phenotypes had similar postoperative outcomes and satisfaction. The limitations of the study included not quantifying patients by ligamentous laxity. In conclusion, arthroscopic treatment of MDI has a low reoperation rate at nine-year follow-up, with some patients still considering the procedure successful despite feelings of instability. Concerns about pathologic soft tissues stretching over time are unfounded, as patient-reported outcomes remained improved and few revision surgeries were required beyond four years. Atraumatic MDI patients can expect similar long-term outcomes as traumatic patients.

Asset Caption

Jordan Gruskay, MD

Keywords

arthroscopic treatment

multidirectional instability

MDI

capsular shift

patient-reported outcomes