Anterior Shoulder Instability Treatment with BLS Method

Abstract

Arthroscopic Bankart repair in treatment of shoulder instability is associated with a high prevalence rate of instability recurrence. The extracapsular stabilization of the glenohumeral joint with enhancement of anterior wall soft tissues could be an alternative and more efficient procedure, especially in case of anterior glenoid bone loss or anterior wall insufficiency. Following this point of view, novel anterior extracapsular stabilization technique—Between glenohumeral Ligaments and Subscapularis tendon (BLS)—was introduced.

Its effectiveness was checked retrospectively by assessing patients with anterior shoulder instability who underwent surgical treatment with a novel arthroscopic BLS technique between 2008 and 2016. A positive outcome was defined as full restoration of joint stability. To evaluate clinical results, pre-operative range of ER and IR measured in 90° of abduction was compared with ER and IR range measured at final follow-up in that same shoulder position. Constant Score and Walch–Duplay Score were also calculated.

A total of 150 patients underwent arthroscopic BLS surgery. During the study period, 50 patients were lost to follow-up, leaving 100 patients for final analysis. At final assessment, 86 patients (86%) were categorized as having a positive outcome, with full restoration of joint stability. Recurrence of shoulder instability was observed in 14 (14%) patients including 6 (6%) cases following major trauma. The frequency of failure was higher in patients with a more severe GBL and with greater baseline range of ER. There was no statistically relevant limitation of external and internal rotation.

The BLS technique has been shown to be an effective way of treatment of anterior shoulder instability for patients without significant glenoid bone loss. It was also shown that this technique does not decrease shoulder range of motion.