Background: Neer and Foster previously described the inferior
capsular shift procedure for treating multidirectional instability
of the shoulder and reported preliminary results that were quite satisfactory.
The purpose of our study was to perform a longer-term follow-up
evaluation of the efficacy of the inferior capsular shift procedure
for treating multidirectional instability of the shoulder.
Methods: An inferior capsular shift procedure
was used to treat multidirectional instability of the shoulder in forty-nine
patients (fifty-two shoulders). All patients had failed to respond
to an exercise program. In this series, the operative approach (anterior
or posterior) was based on the major direction of the instability,
as determined by the preoperative history and physical examination
and as verified by examination with the patient under anesthesia.
In all of the patients, the inferior capsular shift was the primary
attempt at operative stabilization. The repair consisted of a lateral-side
(or humeral-side) shift of the capsule to reduce capsular redundancy and,
when necessary, a reattachment of the avulsed labrum to the anteroinferior
aspect of the glenoid.
Results: A redundant capsular pouch was seen
in all of the shoulders in this series. In addition, detachment
of the anteroinferior aspect of the labrum was found in ten shoulders
and an anterior fracture of the glenoid rim was seen in two shoulders.
At an average of sixty-one months (range, twenty-four to 132 months),
results were available for forty-nine shoulders (forty-six patients).
Thirty shoulders (61 percent) had an excellent overall result, sixteen
(33 percent) had a good result, one (2 percent) had a fair result,
and two (4 percent) had a poor result. Forty-seven (96 percent)
of the forty-nine shoulders remained stable at the time of follow-up.
Two of the thirty-four shoulders that had been repaired through
an anterior approach began to subluxate anteroinferiorly again.
None of the fifteen shoulders that had been repaired through a posterior
approach had recurrent instability. Full function, including the
ability to perform strenuous manual tasks, was restored to forty-five
shoulders (92 percent). A return to sports was possible after thirty-one
(86 percent) of the thirty-six procedures done in athletes; however,
a return to the premorbid level of participation was possible after
only twenty-five (69 percent) of the thirty-six procedures.
Conclusions: The results in this series demonstrate
the efficacy and the durability of the results of the inferior capsular
shift procedure for the treatment of shoulders with multidirectional
instability. The procedure directly addresses the major pathological
feature - a redundant joint capsule. Similar results were seen with
either an anterior or a posterior approach, and we continue to approach
shoulders with multidirectional instability on the side of greatest
instability. A postoperative brace was reserved for patients in
whom a posterior approach had been used or in whom an anterior approach had
involved extensive posterior capsular dissection (ten of the thirty-four
shoulders treated with the anterior approach).