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The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*† by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD J Bone Joint Surg Am Volume 78(2):246-60 February 1, 1996 ©1996 by The Journal of Bone and Joint Surgery, Inc.

The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*† by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD J

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Page 1: The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*† by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD J

The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*†

by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD

J Bone Joint Surg AmVolume 78(2):246-60

February 1, 1996

©1996 by The Journal of Bone and Joint Surgery, Inc.

Page 2: The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*† by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD J

Figs. 1 through 9: Illustrations demonstrating the operative technique.

MICHAEL A. WIRTH et al. J Bone Joint Surg Am 1996;78:246-60

©1996 by The Journal of Bone and Joint Surgery, Inc.

Page 3: The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*† by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD J

Axial view, demonstrating the intended plane of dissection for reflection of the medial and lateral portions of the subscapularis tendon.

MICHAEL A. WIRTH et al. J Bone Joint Surg Am 1996;78:246-60

©1996 by The Journal of Bone and Joint Surgery, Inc.

Page 4: The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*† by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD J

The inferior aspect of the capsule is exposed, and the axillary nerve is protected.

MICHAEL A. WIRTH et al. J Bone Joint Surg Am 1996;78:246-60

©1996 by The Journal of Bone and Joint Surgery, Inc.

Page 5: The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*† by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD J

The anterior aspect of the glenoid is decorticated.

MICHAEL A. WIRTH et al. J Bone Joint Surg Am 1996;78:246-60

©1996 by The Journal of Bone and Joint Surgery, Inc.

Page 6: The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*† by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD J

Non-absorbable sutures are passed through the drill-holes for subsequent repair of the Perthes-Bankart lesion.

MICHAEL A. WIRTH et al. J Bone Joint Surg Am 1996;78:246-60

©1996 by The Journal of Bone and Joint Surgery, Inc.

Page 7: The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*† by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD J

The medial aspect of the capsule is pulled taut in a lateral direction, and the suture is passed through the capsule.

MICHAEL A. WIRTH et al. J Bone Joint Surg Am 1996;78:246-60

©1996 by The Journal of Bone and Joint Surgery, Inc.

Page 8: The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*† by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD J

Any superior capsular defect is closed, followed by superolateral shift of the medial capsular leaflet.

MICHAEL A. WIRTH et al. J Bone Joint Surg Am 1996;78:246-60

©1996 by The Journal of Bone and Joint Surgery, Inc.

Page 9: The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*† by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD J

Figs. 8-A and 8-B: The lateral capsular leaflet is shifted superomedially, which double-breasts the anterior aspect of the capsule.

MICHAEL A. WIRTH et al. J Bone Joint Surg Am 1996;78:246-60

©1996 by The Journal of Bone and Joint Surgery, Inc.

Page 10: The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*† by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD J

Figs. 8-A and 8-B: The lateral capsular leaflet is shifted superomedially, which double-breasts the anterior aspect of the capsule.

MICHAEL A. WIRTH et al. J Bone Joint Surg Am 1996;78:246-60

©1996 by The Journal of Bone and Joint Surgery, Inc.

Page 11: The Capsular Imbrication Procedure for Recurrent Anterior Instability of the Shoulder*† by MICHAEL A. WIRTH, GEORGE BLATTER, and CHARLES A. ROCKWOOD J

The subscapularis tendon is reapproximated.

MICHAEL A. WIRTH et al. J Bone Joint Surg Am 1996;78:246-60

©1996 by The Journal of Bone and Joint Surgery, Inc.