Surgical Techniques

1.  Arthroscopic Posterior Bankart Repair +/- Capsular Plication


Posterior Labral TearPosteior Labral Repair




Posterior Portal

- make slightly inferior and lateral compare to normal

- inspect joint

- place anterior portal +/- ASL portal


Remove cameral and place thorough anterior portal

- place 8 mm cannula through posterior cameral portal (over switching stick)


Often need second portal lateral and inferior to place inferior anchor

- can use simple stab incision here


Assess labrum and capsule

- repair posterior bankart

- plicate redundant / patulous capsule




Kim et al JBJS Am 2003

- 27 patients with unidirectional posterior instability

- all with labral injuries, most with capsular laxity

- all had arthroscopic posterior labral repair and capsular shift

- only one recurrence


Pennington Arthroscopy 2010

- 28 athletes with pure posterior labral pathology

- 93% return to sport


Bradley et al Am J Sports Med 2006

- 91 athletes with 100 shoulders with unilateral posterior instability

- variations of suture anchor labral repair / anchor capsulolabral repair / capsular plication sutures

- 30% posterior labral tear, 43% patulous capsule with no labral pathology

- remainder combination injuries including partial labral tears

- 8% failure rate, all with capsular laxity

- patients had evidence of chondrolabral retroversion


2.  Open Posterior Capsular shift 


Open Technique



- lateral



- vertical incision

- posterior axillary fold


Shoulder Posterior Approach


Superficial dissection

- split deltoid to expose infraspintous

- elevate IS off capusle

- L shaped incision infraspinatous after tagging sutures medial

- T shaped capsulotomy of capsule for posterior shift (vertical limb on humeral insertion)



- no more than 1.5cm medial to glenoid to protech SS nerve

- axillary nerve through quadrangular space below Tm



- labral detachment reattached if present

- graft glenoid with bone from spine / iliac crest if defect

- inferior capsule shifted superiorly

- reinforced with superior limb of capsule

- may augment with IS tensioning


3. Posterior Glenoid Osteotomy


Reserved for in setting of severe posterior retroversion with instability


Posterior glenoid osteotomy