title: Anteromedial capsular redundancy and labral deficiency in shoulder instability.
abstract: BACKGROUND
  Redundancy of the anteromedial capsule of the shoulder may persist despite proper tensioning of the capsule and repair of a Bankart lesion during an anteroinferior capsular shift procedure.
  
  
  OBJECTIVE
  A barrel-stitch suture technique incorporated into a capsular shift procedure is effective in achieving satisfactory shoulder stability.
  
  
  METHODS
  Uncontrolled retrospective review.
  
  
  METHODS
  A barrel-stitch technique was used for patients identified as having anteromedial capsular redundancy during a capsular shift procedure for anteroinferior instability.
  
  
  RESULTS
  The incidence of anteromedial capsular redundancy and labral deficiency was 49% (38 of 78). Patients with anteromedial capsular redundancy had a significantly greater number of dislocations before surgery (16.1 +/- 21.3 versus 7.4 +/- 7.4) and a greater duration of symptoms (79.8 +/- 84.2 versus 31.6 +/- 32.2 months). The mean postoperative Rowe score of patients with anteromedial capsular redundancy was 88.7 +/- 14.8, with 92% having excellent or good results, compared with 88.9 +/- 14.8 in the remaining patients and 93% excellent or good results.
  
  
  CONCLUSIONS
  Anteromedial capsular redundancy is associated with longer preoperative duration of symptoms and more dislocations, but effective treatment can be achieved with a capsular shift procedure augmented with medial capsular imbrication with a barrel stitch.
authors.affiliation: Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, New York 10032, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ahmad
authors.forename: Michael Q
authors.initials: MQ
authors.lastname: Freehill
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Blaine
authors.forename: William N
authors.initials: WN
authors.lastname: Levine
authors.forename: Louis U
authors.initials: LU
authors.lastname: Bigliani
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000503:physiopathology / Q000601:surgery*; D007593:Joint Instability / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome