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Clin Shoulder Elb > Volume 19(3); 2016 > Article
Clinics in Shoulder and Elbow 2016;19(3):155-162.
DOI:    Published online September 30, 2016.
Assessment of Capsular Insertion Type and of Capsular Elongation in Patients with Anterior Shoulder Instability and It's Correlation with Surgical Outcome: A Quantitative Assessment with Computed Tomography Arthrography
Do Hoon Kim, Do Yeon Kim, Hye Yeon Choi, Ji Soon Park, Ye Hyun Lee, Joo Han Oh
1Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
2Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea.
3Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, Korea.
4Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea.
Received: 29 December 2015   • Revised: 25 May 2016   • Accepted: 27 May 2016
BACKGROUND: The study aimed to determine the type of capsular insertion and the extent of capsular elongation in anterior shoulder instability by quantitatively evaluating their computed tomography arthrographic (CTA) findings, and to investigate the correlation of these parameters with surgical outcomes.
We retrospectively reviewed 71 patients who underwent CTA and arthroscopic capsulolabral reconstruction for anterior shoulder instability between April 2004 and August 2008. The control group comprised 72 patients diagnosed as isolated type II superior labrum anterior to posterior (SLAP) lesion during the period. Among the 143 patients, 71 were examined with follow-up CTA at an average 13.8 months after surgery. It was measured the capsular length and cross-sectional area at two distinct capsular regions: the 4 and 5 o'clock position of the capsule.
With regards to the incidence of the type of anterior capsular insertion, type I was more common in the control group, whereas type III more common than in the instability group. Anterior capsular length and cross-sectional area were significantly greater in the instability group than in the control group. Among patients of the instability group, the number of dislocations and the presence of anterior labroligamentous periosteal sleeve avulsion lesion were significantly associated with anterior capsular redundancy. Postoperatively, recurrence was found in 3 patients (4.2%) and their postoperative capsular length and cross-sectional area were greater than those of patients without recurrence.
Capsular insertion type and capsular redundancy derived through CTA may serve as important parameters for the management of anterior shoulder instability.
Key Words: Capsular elongation; Computed tomography; Arthrography; Joint instability; Shoulder
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