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Background: Revision Bankart operations frequently show capsulolabral buttress loss and recurrent soft tissue Bankart lesion. Capsulolabral augmentation is designed to increase glenohumeral stability by 2 separate mechanisms: deepening the glenoid concavity and reducing capsular laxity. This is accomplished by shifting the capsule to buttress the glenoid labrum.

Hypothesis: A retained capsulolabral buttress may show loss of height and slope at a certain period after surgery, regardless of stability. Thus, the authors wanted to confirm the importance of an intraoperative establishment of capsulolabral buttress in terms of stability.

Study Design: Case-control study; Level of evidence, 3.

Methods: Arthroscopically repaired Bankart lesions in 21 consecutive shoulders that showed no frank dislocation were evaluated using axial and oblique coronal T2-weighted magnetic resonance imaging at 3 timepoints (preoperative period, average postoperative week 6 and a nearly full range of motion recovery, and postoperative month 6 with a return to daily activity). The authors measured 2 parameters (height and slope) on axial (mainly capsulolabral containment) and oblique coronal images (mainly inferior glenohumeral ligament) at the anteroinferior portion of the glenoid (5 mm above the most inferior anchor). In addition, they compared the above-mentioned parameters at postoperative month 6 by magnetic resonance imaging in 21 controls and in 21 patients whose instability recurred after surgery (not included in the prospective study).

Results: There was a significant increase between the preoperative period and postoperative week 6 in all 4 parameters (P < .0001). There was also a significant increase between the preoperative period and postoperative month 6 in all 4 parameters (P < .0001). However, no statistically significant difference was observed between postoperative week 6 and postoperative month 6 in all 4 parameters (P > .1). Furthermore, significant differences were observed between normal controls and patients with recurrent instability (P < .001) and between the authors’ cases and patients with recurrent instability not in the study (P < .001). However, no difference was observed between their cases and normal shoulders (P > .1).

Conclusion: After suture anchor Bankart repair, initial capsulolabral buttress property was maintained at 6 months postoperatively. Furthermore, the buttress was more prominent in stable and normal shoulders than in recurrent instability shoulders. Therefore, the authors believe that the establishment of a capsulolabral buttress is meaningful during Bankart repair.

Background: Although increased capsular volume has been implicated in shoulder instability, there is a paucity of clinical evidence to quantify the size of the capsule with specific instability conditions of the shoulder.

Hypothesis: Shoulder capsular area, as measured by magnetic resonance arthrography, is increased with specific patterns of shoulder instability.

Study Design: Cross-sectional study; Level of evidence, 4.

Methods: During an 8-month period, all patients with a diagnosis of anterior (n = 19), posterior (n = 14), or multidirectional (n = 13) instability of the shoulder and who were assessed with a magnetic resonance arthrogram were reviewed. A group of 10 control patients without clinical instability were also identified. The magnetic resonance arthrograms of all groups were randomly mixed, and 5 reviewers recorded measures of capsular length and area and determined labral abnormalities. The magnetic resonance arthrogram measurements were compared between groups, and interobserver agreement was determined.

Results: The cross-sectional area of the capsule was increased in patients with posterior (P = .017) or multidirectional instability (P = .021) versus controls, but not in patients with anterior instability. Additionally, the posteroinferior cross-sectional area was increased in patients with posterior (P = .001), multidirectional (P = .003), and anterior (P = .008) instability. In patients with a posterior labral tear, the mean axial (P = .043) and mean posteroinferior sagittal cross-sectional area (P = .011) was increased, but there were no differences in cross-sectional area for those with an anterior labral tear. The overall interobserver reliability was very good (correlation coefficient range, 0.68–0.94).

Conclusion: Our results reinforce the concept that capsular elongation and laxity, either preexisting or acquired, play a role in certain instability conditions of the shoulder. Additional work is needed to determine how to correlate surgical decision making with the cross-sectional area measurements demonstrated in this study.