Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Principles of Instability Surgery

The goal of treatment in both open and arthroscopic instability surgery is twofold: to restore the labrum to its anatomic attachment site and to re-establish the appropriate tension to the inferior capsuloligamentous complex of the joint. Cadaveric studies have shown that both the labrum and the capsule must be injured for a dislocation to occur.

If the labrum is torn (Bankart or posterior/reverse Bankart lesion), it should be repaired anatomically to the rim of the glenoid. Capsular laxity can be addressed by the superior and medial shift of the capsule. Plication can be used to increase the tension in the capsule and decrease laxity. In situations in which labral tears are not present and the principal pathology is redundant capsule, a plication should be performed on the appropriate side of the joint to decrease capsular volume and prevent translation.

In patients with MDI, the plication is performed inferiorly, posteriorly, and anteriorly. The rotator interval should always be closed in patients with MDI or posterior instability.

Associated injuries to the rotator cuff or superior labrum should be repaired surgically. In rare instances, midcapsular ruptures of the glenohumeral capsule or humeral avulsions of the glenohumeral ligaments (HAGL lesions) are discovered. If these lesions cannot be effectively treated arthroscopically, the surgeon should convert to an open procedure.

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