Open Repairs for the Treatment of Anterior Shoulder Instability

• Published in: The American journal of sports medicine 2003-01, Vol.31 (1), p.142-153
• Main Authors: Gill, Thomas J., Zarins, Bertram
• Format: Article
• Language: English
• Subjects: Age Factors; Biological and medical sciences; Diseases of the osteoarticular system; Dislocation; Humans; Hypermobility; Joint Capsule - physiopathology; Joint Capsule - surgery; Joint instability; Joint Instability - physiopathology; Joint Instability - therapy; Joints; Medical sciences; Miscellaneous. Osteoarticular involvement in other diseases; Orthopedic Procedures - methods; Orthopedic surgery; Shoulder; Shoulder dislocation; Shoulder Dislocation - surgery; Shoulder joint; Shoulder Joint - anatomy & histology; Shoulder Joint - physiopathology; Shoulder Joint - surgery; Sports injuries; Sports medicine; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/03635465030310011001

Successful treatment of anterior instability of the shoulder requires a balance between restoring joint stability and minimizing loss of glenohumeral motion. The choice of treatment should be individualized on the basis of the patient’s occupation and level of participation in sports, as well as on the degree of instability of the shoulder. Despite discussions to the contrary, there is no single “essential lesion,” as proposed by Bankart, that is responsible for recurrent anterior shoulder instability, although the Bankart lesion is by far the most important. The choice of operative treatment must be tailored to correct the abnormality that is identified at the time of surgery. A variety of promising arthroscopic techniques have been developed for the treatment of anterior shoulder instability; however, open stabilization remains the standard, especially for severe instabilities, revision procedures, and for athletes who participate in contact sports. This article will review the open surgical techniques used for treatment of anterior instability of the shoulder. Both current and historical operations will be discussed. Regardless of which procedure is chosen by a surgeon, the treatment should follow the guidelines taught by Rowe: anatomic dissection at the time of surgery, identification and repair of the lesions responsible for the instability, returning tissues to their anatomic locations, and early postoperative range of motion. By following these guidelines, the results of treatment of anterior instability of the shoulder can be optimized.