Posterior Labral Repair With Capsular Plication Shows Enduring Mid-Term Outcomes and Return to Sports With Low Recurrence Rates.

Abstract

Purpose: To evaluate mid-term (>5-year) clinical outcomes, recurrence rates, and return to sports in a cohort of patients undergoing arthroscopic posterior labral repair and capsular plication.

Methods: We conducted a retrospective review of patients who underwent isolated posterior labral repairs with capsular plication for posterior shoulder instability with a minimum follow-up period of 8 years. We included patients who (1) underwent arthroscopic posterior labral repair and capsular plication as the index procedure, (2) had minimum 8-year follow-up, (3) were older than 18 years at the time of final follow-up, and (4) had complete patient-reported outcome measures at final follow-up. Clinical outcomes were assessed using the Rowe score, American Shoulder and Elbow Surgeons (ASES) score, and Single Assessment Numeric Evaluation (SANE) score at baseline, 1-year follow-up, and final follow-up. Recurrence rates, complications, and return to sports were also evaluated. The proportions of patients achieving the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) were calculated for each outcome measure using established thresholds.

Results: Forty-seven patients met the inclusion criteria, with a mean age at surgery of 20.7 ± 4.1 years, and 87.2% were male patients. At a mean final follow-up of 10.2 years (range, 8.0-13.6 years), the mean Rowe, ASES, and SANE scores were 89.5 ± 13.0, 87.8 ± 12.8, and 83.8 ± 7.7, respectively, showing significant improvements from baseline. The MCID was achieved by 97.9% of patients for the Rowe score, 100% for the ASES score, and 85.1% for the SANE score. The PASS was achieved by 66% of patients for the Rowe score, 83% for the ASES score, and 68% for the SANE score. Three patients (6.4%) experienced recurrent instability, with a mean time to recurrence of 21.3 ± 1.5 months. Two patients underwent revision surgery. Most patients (91.5%) returned to sports, at an average time of 5.4 ± 1.0 months after surgery, with 78.7% returning at the same level as before the injury.

Conclusions: Arthroscopic repair for posterior shoulder instability yields favorable mid-term outcomes, with significant improvements in functional scores and a low recurrence rate at a mean follow-up of 10.6 years. A high proportion of patients achieved the MCID and PASS for all outcome measures, indicating clinically meaningful improvements in shoulder function and patient satisfaction. Most patients successfully returned to sports, with nearly 80% returning at their preinjury level. These findings support the durability and effectiveness of arthroscopic repair in managing posterior shoulder instability, helping patients maintain a high level of shoulder function and sports participation over an extended period.

Level of evidence: Level IV, retrospective case series.