Indication and technique for arthroscopic stabilization of anterior shoulder instability with multidirectional laxity

As concomitant hyperlaxity has been identified as an independent risk factor for failure following anterior shoulder stabilization, the treatment of this special pathology remains challenging. There is a broad consensus that a clear differentiation to multidirectional instability and isolated anteroinferior instability should be ensured to avoid unsatisfactory outcomes. Typical features of this patient collective include positive clinical tests for anteroinferior instability and multidirectional shoulder hyperlaxity, findings of an anterior labral lesion and general capsular redundancy in the radiologic assessment, while tests for posterior instability are negative. Surgical treatment should consist of an anteroinferior capsulolabroplasty with concomitant posteroinferior plication to reduce pathological capsular volume. Although there is a lack of clinical evidence, biomechanical investigations suggest that a four-anchor construct with three anterior anchors and one posteroinferior anchor may be sufficient to restore glenohumeral stability. This surgical approach is presented and discussed in the current article.