POSTERIOR SHOULDER INSTABILITY IN ATHLETES: SURGICAL TREATMENT WITH POSTERIOR BONE BLOCK

Abstract

Purpose of the study: Sports activities requiring antepulsion, adduction and medial rotation can favor the development of posterior instability of the shoulder. Conservative treatment is indicated, but many techniques have been proposed in case of failure. All do not allow recovery of the same sports level. We report our experience with six cases of posterior shoulder instability treated with a Gosset posterior bone block.

Material and methods: We retrospectively reviewed cases treated between 1974 and 1995. Six athletes, aged 17 to 34 years (mean 25 years) underwent posterior bone block surgery using the Gosset procedure on their dominant shoulder. Three of the patients had experienced involuntary dislocation and three others involuntary and voluntary dislocation. One patient had a multidirectional hyperlaxity. Five patients had participated in rehabilitation programs for at least five months. Two patients had undergone unsuccessful bone block surgery in another unit.

Results: Stability and pain relief were achieved in all cases. Three patients recovered complete mobility. In the three others, mean limitation of mobility for the different sectors was 15°. There has been no sign of osteoarthrosis at three years follow-up. All patients have resumed their sports activities, three at the same level.

Discussion: In our experience, most surgical techniques proposed for the treatment of posterior shoulder instability are unsuccessful. The Gosset iliac bone block prolongs the articular surface. After consolidation, it allows sports activities requiring shoulder force and provides satisfactory mobility.