title: Diagnosis and treatment of anteroinferior capsular redundancy associated with anterior shoulder instability using an open Latarjet procedure and capsulorrhaphy.
abstract: OBJECTIVE
  There is a paucity of data detailing management of anterior capsular redundancy (ACR) when using the Latarjet procedure for unidirectional instability. This study aimed to describe the surgical management and to assess the clinical profile of patients presenting with anterior capsular redundancy [ACR(+)] with anterior shoulder instability.
  
  
  METHODS
  Seventy-seven patients who had a Latarjet procedure were followed for a 55-month period. Per-operative ACR was assessed during surgery. ACR was considered present if the inferior capsular flap of a Neer T-shaft capsulorrhaphy was able to cover the superior capsular flap with the arm in the neutral position. Patients with ACR(+) received an additional Neer capsulorrhaphy, while patients with ACR(-) did not. This per-operative finding was correlated with demographics, clinical, radiological pre-operative data and surgical outcome.
  
  
  RESULTS
  Patients presenting with a per-operative ACR(+) were significantly associated with a sulcus sign (P < 0.001), a Beighton score >4 (P < 0.01), a low-energy instability history (P < 0.05), a predominant history of subluxations (P < 0.05), fewer Hill-Sachs lesion (P < 0.05) and a female gender (P < 0.05), but not significantly with external rotation >85°. Open standard Latarjet procedures with Neer capsulorrhaphy in ACR(+) patients showed excellent or good results and stability rate of 95 %. All patients except four who presented with a new dislocation after surgery were satisfied with their outcome. Thirteen patients (16 %) had a persistent apprehension sign at the last follow-up. ACR(+) and ACR(-) groups did not show significant difference in the mean values of Rowe, Walch-Duplay and Constant-Murley scores.
  
  
  CONCLUSIONS
  ACR correlated with a sulcus sign, Beighton score and instability history. In anterior shoulder instability associated with ACR, the Latarjet procedure with a Neer capsulorrhaphy appears a satisfactory treatment alternative to arthroscopic or open capsular shift. It decreased apprehension in comparison with Latarjet procedures without capsular repair.
  
  
  METHODS
  Cases series, treatment study, Level IV.
authors.affiliation: Orthopedics and Trauma Department, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35000, Rennes, France. mickael.ropars@chu-rennes.fr.|M2S Lab (Mouvement Sport Santé), University Rennes 2 - ENS Rennes - UEB, Avenue Robert Schuman, Campus de Ker Lann, 35170, Bruz, France. mickael.ropars@chu-rennes.fr.
authors.forename: Mickaël
authors.initials: M
authors.lastname: Ropars
authors.affiliation: M2S Lab (Mouvement Sport Santé), University Rennes 2 - ENS Rennes - UEB, Avenue Robert Schuman, Campus de Ker Lann, 35170, Bruz, France.
authors.forename: Armel
authors.initials: A
authors.lastname: Cretual
authors.affiliation: Orthopedics and Trauma Department, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35000, Rennes, France.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Kaila
authors.affiliation: M2S Lab (Mouvement Sport Santé), University Rennes 2 - ENS Rennes - UEB, Avenue Robert Schuman, Campus de Ker Lann, 35170, Bruz, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bonan
authors.affiliation: Orthopedics and Trauma Department, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35000, Rennes, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Hervé
authors.affiliation: Orthopedics and Trauma Department, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35000, Rennes, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Thomazeau
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000601:surgery*; D007592:Joint Diseases / Q000175:diagnosis / Q000601:surgery; D007593:Joint Instability / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D010808:Physical Examination; D012008:Recurrence; D012189:Retrospective Studies; D012399:Rotation; D012783:Shoulder Dislocation / Q000175:diagnosis / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*; D055815:Young Adult
keywords: Bristow–Latarjet; Multidirectional instability; Open shoulder stabilization; Shoulder instability; Shoulder laxity