Arthroscopic Management of Recurrent Glenohumeral Instability

Recurrent glenohumeral instability can be a debilitating condition that affects an athlete's ability to compete at the highest levels of competition and, in our military population, meet the demands of active military service. Significant advances in the understanding of the natural history of this condition have led to new operative interventions and rehabilitative protocols that aim to return the athlete to their previous level of activity. There has been increased interest in the arthroscopic stabilization of shoulder instability, which is evolving from first-time dislocators to recurrent instability in noncontact and contact athletes as well. A thorough understanding of the pathoanatomy involved in shoulder instability allows us to address all injured structures responsible for recurrent instability including the Bankart tear (reverse Bankart for posterior instability) and loss of capsuloligamentous tension. As our arthroscopic techniques continue to improve, our clinical results will approach that of traditional open techniques with perhaps less perioperative morbidity and loss of motion. We have presented one such arthroscopic technique of a multipleated plication through a single anterior and posterior portal that has served us well in the management of recurrent shoulder instability. At present, the only contra-indication to an arthroscopic procedure is significant bony defects of the humeral head or glenoid, which requires a more extensive intervention.