Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “instability”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMed2001

Prevalence of knee instability in relation to sports activity.

The objective was to estimate the prevalence of knee instability among active athletes and to investigate potential associations to type, amount and duration of sports participation. Based on a questionnaire, 339 athletes provided information about different features of occupation, sports activity and knee instability. The 12-month period prevalence of knee instability and constant or recurrent knee instability, and absence from sport and absence from work due to knee instability, was 22%, 14%, 5% and 1%, respectively. Knee instability as such, and constant or recurrent knee instability were found to be positively associated with female gender and different features of occupational work. In conclusion, knee instability is a commonly reported phenomenon among active athletes. It was found to be independent of the type and the amount of sports activity but highly dependent on female gender, type and amount of occupational work.

Adolescent↗
PubMed2004

Microsatellite instability in gastric MALT lymphoma.

The role of microsatellite instability and defects in DNA mismatch repair mechanism in the pathogenesis of gastric lymphoma of mucosa-associated lymphoid tissue (MALT) type is still controversial, as both negative and positive findings have been reported. This may be explained mainly by arbitrary selection of the tested loci, the use of various techniques of microsatellite instability analysis and by different definitions of replication error positive phenotype. The aim of our study was to evaluate the instability at selected microsatellite markers using the GeneScan Analysis Software. DNA from paraffin-embedded tissue blocks of 13 previously untreated patients with localized gastric MALT lymphoma was extracted. Five microsatellite markers, which are located in hMSH2, hMLH1, P16, APC and MLL loci, were selected from the genetic database. We found genetic instability in tumors of 9/13 patients with gastric MALT lymphoma (69%). Seven of them had replication-error-positive phenotype (54%). Microsatellite instability was found in 39% of the samples in the MLL locus, 39% in the APC, 46% in the P16, 23% in the hMLH1 and none in the hMSH2. This study demonstrates that microsatellite instability has more prominent role in pathogenesis of gastric MALT lymphoma than reported to date. We suggest that microsatellite instability should be analyzed with markers adjacent to chromosomal loci that are involved in lymphomas. Our findings support the 'Real Common Target genes' theory of high rate of microsatellite instability in specific genes, which are associated with related tumors.

Adult↗
PubMedDate not supplied

The natural course of atraumatic shoulder instability.

Over the years, we have observed a shifting among loose shoulder, voluntary dislocation, habitual dislocation, and sustained subluxation, leading us to the conclusion that they are all varieties of the same condition: atraumatic shoulder instability. For this study, we followed the natural course of atraumatic shoulder instability in 341 patients (573 shoulders) for 3 years or more. There were 467 cases of loose shoulder, 49 cases of voluntary dislocation, 56 cases of habitual dislocation, and 1 case of sustained subluxation. The average follow-up period was 4 years and 6 months. Spontaneous recovery occurred in 50 cases. The average age of patients at the onset of atraumatic shoulder instability who exhibited a change in instability was 14.6 years. The average age of patients at the onset of atraumatic shoulder instability who exhibited no change in shoulder instability was 19.4 years. There was a significant difference of P < .01 in the age of onset between these two groups. The incidence of spontaneous recovery in the group that discontinued overhead sports was 8.7 times greater than in the group that continued to play overhead sports. The incidence of spontaneous recovery in the group that discontinued non-overhead sports was only 1.4 times greater than in the group that continued to play non-overhead sports. However, no instance of spontaneous recovery was observed among patients who changed from playing non-overhead sports to playing overhead sports. The spontaneous recovery of atraumatic shoulder instability encountered in this study shows that it is best to place priority on observing the course of atraumatic shoulder instability for several years and to avoid performing unnecessary surgery.

Activities of Daily Living↗
PubMed2004

Chromosome instabilities and programmed cell death in tapetal cells of maize with B chromosomes and effects on pollen viability.

B chromosomes (B's), knobbed chromosomes, and chromosome 6 (NOR) of maize undergo nondisjunction and micronucleus formation in binucleate tapetal cells. These chromosome instabilities are regular events in the program of tapetal cell death, but the B's strongly increase A chromosome instability. We studied 1B and 0B plants belonging to selected lines for high or low B transmission rate and their F1 hybrids. These lines are characterized by meiotic conservation or loss of B chromosomes, respectively. The female B transmission (fBtl) allele(s) for low B transmission is dominant, inducing micronucleus formation and B nondisjunction. We hypothesize that the fBtl allele(s) induces knob instability. This instability would be sufficient to produce B loss in both meiocytes and binucleate tapetal cells. B instability could, in turn, produce instabilities in all chromosomes of maize complement. To establish whether the chromosomal instabilities are related to the tapetal programmed cell death (PCD) process, we applied the TUNEL technique. PCD, estimated as the frequency of binucleate tapetal cells with TUNEL label, was significantly correlated with the formation of micronuclei and the frequency of pollen abortion. It can be concluded that the observed chromosome instabilities are important to the PCD process and to the development of microspores to form viable pollen grains.

Apoptosis↗
PubMed1990

Analysis of sagittal plane instability of the lumbar spine in vivo.

Segmental instability secondary to degenerative disc disease may result in chronic low-back pain. In the sagittal plane, segmental instability can be characterized during lumbar motion from full extension to full flexion. The authors studied this movement using a translational method for the kinematic analysis, implementing a new concept known as the instability factor. Both translational and angular components of motion are evaluated. By computing the incremental motion parameters at different stages of spinal bending, the total amount of translation and angulation is obtained and combined in a ratio termed the instability factor. This factor increases with linear instability and decreases with rotational instability. The authors reviewed 12 control subjects and 36 patients with chronic low-back pain. The diagnoses of patients were categorized into three groups: idiopathic low-back pain, lumbar disc prolapse, and degenerative disc disease. Lateral radiographs of each subject's spine at the L4-5 level were obtained using low dose radiography and were performed serially as the subjects moved from full extension to full flexion. It was found that the group of patients with degenerative disc disease had an average age-corrected instability factor of 37.3 (mm/radian), which was significantly larger than that of normal subjects 25.5 (mm/radian), (P = 0.0065). No significant difference was seen in the instability factor of patients with idiopathic low-back pain or lumbar disc prolapse.

Adult↗
PubMed1999

Is stress radiography necessary in the diagnosis of acute or chronic ankle instability?

BACKGROUND: Clinicians often use the talar tilt (TT) and anterior drawer (AD) stress x-rays to diagnose acute or chronic mechanical ankle instability. However, the wide range of TT and AD values in normal and injured ankles makes interpretation of the test results difficult. OBJECTIVE: To critically review the literature and determine the accuracy of stress radiography in the diagnosis of mechanical ankle instability. DATA SOURCES: MEDLINE was searched for relevant articles published since 1966 using MEDLINE subject headings (MeSH) and textwords for English articles related to ankle injuries and radiography. Additional references were reviewed from the bibliographies of the retrieved articles. The total number of articles reviewed was 67. Of these, 8 studies met criteria for inclusion and were analyzed. STUDY SELECTION: Only clinical studies that used surgical exploration as the gold standard for diagnosing lateral ligament rupture were evaluated for this study. Cadaver or laboratory studies were excluded. DATA EXTRACTION AND SYNTHESIS: In reviewing the literature, pertinent strengths of the different study designs were emphasized. From these data, particular attention was paid to the diagnostic accuracy of each study in comparing TT and AD stress x-rays to surgical confirmation of lateral ligament rupture. MAIN RESULTS: A total of eight prospective clinical series satisfied the inclusion criteria. Seven of the eight assessed acute ankle instability as the outcome and one assessed chronic ankle instability. Of the seven studies that focused on acute ankle injuries, only one concluded significant benefit in using stress views to diagnose lateral ligament rupture. Three of the seven reported a positive relationship between stress radiography and surgical findings, although all six studies concluded that TT and AD stress x-rays are not reliable enough to make the diagnosis. The authors who assessed chronic ankle instability stated that TT and AD stress views combined were not useful in defining ankle instability. CONCLUSION: The published data regarding TT and AD stress x-rays are too variable to determine accepted normal values compared with injured values. There are insufficient data for comparison of the use of mechanical versus manual techniques, or use of local anesthetic to facilitate the stress test. Because the treatment evolution of all acute ankle sprains is toward functional nonoperative treatment and because treatment does not depend on the degree of ankle instability on stress views, the TT and AD stress x-rays have no clinical relevance in the acute situation. In cases of chronic instability, the large variability in TT and AD values in both injured and noninjured ankles precludes their routine use.

Acute Disease↗
PubMed2006

Recurrent instability after total hip arthroplasty: beware of subtle component malpositioning.

Most patients exhibiting instability after total hip arthroplasty can be treated nonoperatively. However, instability may become recurrent and require surgical intervention. Abductor insufficiency and component malpositioning constitute two of the most important causes of recurrent instability, although the exact cause may not be identifiable in some patients. There is relative scarcity of reports in the literature regarding the outcome of surgical intervention for recurrent instability; however, it is known that surgical intervention is likely to have a better outcome in patients for whom the cause of recurrent instability can be identified. We hypothesized that component malpositioning, which may be subtle in some cases, is the cause of recurrent instability for many patients. The outcomes of revision arthroplasty in 93 patients who were treated at our institution for recurrent instability were reviewed. Component malpositioning was found to be the major cause of recurrent instability in this successfully treated cohort.

Adult↗
PubMed2005

Cycles of chromosome instability are associated with a fragile site and are increased by defects in DNA replication and checkpoint controls in yeast.

We report here that a normal budding yeast chromosome (ChrVII) can undergo remarkable cycles of chromosome instability. The events associated with cycles of instability caused a distinctive "sectoring" of colonies on selective agar plates. We found that instability initiated at any of several sites on ChrVII, and was sharply increased by the disruption of DNA replication or by defects in checkpoint controls. We studied in detail the cycles of instability associated with one particular chromosomal site (the "403 site"). This site contained multiple tRNA genes known to stall replication forks, and when deleted, the overall frequency of sectoring was reduced. Instability of the 403 site involved multiple nonallelic recombination events that led to the formation of a monocentric translocation. This translocation remained unstable, frequently undergoing either loss or recombination events linked to the translocation junction. These results suggest a model in which instability initiates at specific chromosomal sites that stall replication forks. Forks not stabilized by checkpoint proteins break and undergo multiple rounds of nonallelic recombination to form translocations. Some translocations remain unstable because they join two "incompatible" chromosomal regions. Cycles of instability of this normal yeast chromosome may be relevant to chromosome instability of mammalian fragile sites and of chromosomes in cancer cells.

Cell Cycle Proteins↗
PubMed2004

An evaluation of the apprehension, relocation, and surprise tests for anterior shoulder instability.

BACKGROUND: Although there are many studies describing tests for shoulder instability, there are few assessing the validity of these tests in diagnosing anterior shoulder instability. PURPOSE: To assess the validity of the apprehension, relocation, and surprise tests as predictors of anterior shoulder instability. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: Forty-six patients with a clear diagnosis of one of the following shoulder disorders were evaluated by four independent, blinded examiners: traumatic anterior instability (18), rotator cuff tendinosis (17), posterior instability (2), glenohumeral osteoarthritis (4), or multidirectional instability (5). Interobserver reliability was also determined. RESULTS: In subjects who had a feeling of apprehension on all three tests, the mean positive and negative predictive values were 93.6% and 71.9%, respectively. The surprise test was the single most accurate test (sensitivity = 63.89%; specificity = 98.91%). An improvement in the feeling of apprehension or pain with the relocation test added little to the value of the tests. Interobserver reliability was determined to be 0.83. CONCLUSIONS: and CLINICAL RELEVANCE: The results of this study suggest that a positive instability exam on all three tests is highly specific and predictive of traumatic anterior glenohumeral instability.

Fear↗
PubMedDate not supplied

Relevance of arm position and muscle activity on three-dimensional glenohumeral translation in patients with traumatic and atraumatic shoulder instability.

BACKGROUND: No quantitative data on glenohumeral translation exist allowing one to distinguish insufficiency of the active or passive stabilizers in different forms of shoulder instability. HYPOTHESIS: To determine whether 1) in traumatic or atraumatic shoulder instability an increase of glenohumeral translation can be observed in specific relevant arm positions, 2) muscle activity leads to recentering of the humeral head, and 3) there exist differences between traumatic and atraumatic instability. STUDY DESIGN: Prospective clinical trial. METHODS: In 12 patients with traumatic and 10 patients with atraumatic instability, both shoulders were examined in different arm positions-with and without muscle activity-by using open magnetic resonance imaging and a three-dimensional postprocessing technique. RESULTS: At 90 degrees of abduction and external rotation, translation (anterior-inferior) was significantly higher in patients with traumatic unstable shoulders compared with their contralateral side (3.6 +/- 1.5 versus 0.7 +/- 1.6 mm). In patients with atraumatic instability, significantly increased translation (4.7 +/- 2.0 mm) was observed, with the direction being nonuniform. Muscle activity led to significant recentering in traumatic but not in atraumatic instability. CONCLUSIONS: In traumatic instability, increased translation was observed only in functionally important arm positions, whereas intact active stabilizers demonstrate sufficient recentering. In atraumatic instability, a decentralized head position was recorded also during muscle activity, suggesting alterations of the active stabilizers. CLINICAL RELEVANCE: These data are relevant for optimizing diagnostics and therapeutic strategies.

Adolescent↗
PubMedDate not supplied

Open repairs for the treatment of anterior shoulder instability.

Successful treatment of anterior instability of the shoulder requires a balance between restoring joint stability and minimizing loss of glenohumeral motion. The choice of treatment should be individualized on the basis of the patient's occupation and level of participation in sports, as well as on the degree of instability of the shoulder. Despite discussions to the contrary, there is no single "essential lesion," as proposed by Bankart, that is responsible for recurrent anterior shoulder instability, although the Bankart lesion is by far the most important. The choice of operative treatment must be tailored to correct the abnormality that is identified at the time of surgery. A variety of promising arthroscopic techniques have been developed for the treatment of anterior shoulder instability; however, open stabilization remains the standard, especially for severe instabilities, revision procedures, and for athletes who participate in contact sports. This article will review the open surgical techniques used for treatment of anterior instability of the shoulder. Both current and historical operations will be discussed. Regardless of which procedure is chosen by a surgeon, the treatment should follow the guidelines taught by Rowe: anatomic dissection at the time of surgery, identification and repair of the lesions responsible for the instability, returning tissues to their anatomic locations, and early postoperative range of motion. By following these guidelines, the results of treatment of anterior instability of the shoulder can be optimized.

Age Factors↗
PubMed2004

Nonoperative management for in-season athletes with anterior shoulder instability.

BACKGROUND: Acute or recurrent anterior shoulder instability is a frequent injury for in-season athletes. Treatment options for this injury include shoulder immobilization, rehabilitation, and shoulder stabilization surgery. PURPOSE: To determine if in-season athletes can be returned to their sports quickly and effectively after nonoperative treatment for an anterior instability episode. METHODS: Over a 2-year period, 30 athletes matched the inclusion criteria for this study. Nineteen athletes had experienced anterior dislocations, and 11 had experienced subluxations. All were treated with physical therapy and fitted, if appropriate, with a brace. These athletes were followed for the number of recurrent instability episodes, additional injuries, subjective ability to compete, and ability to complete their season or seasons of choice. RESULTS: Twenty-six of 30 athletes were able to return to their sports for the complete season at an average time missed of 10.2 days (range, 0-30 years). Ten athletes suffered sport-related recurrent instability episodes (range, 0-8 years). An average of 1.4 recurrent instability episodes per season per athlete occurred. There were no further injuries attributable to the shoulder instability. Sixteen athletes underwent surgical stabilization for their shoulders during the subsequent off-season. CONCLUSIONS: Most of the athletes were able to return to their sport and complete their seasons after an episode of anterior shoulder instability, although 37% experienced at least 1 additional episode of instability during the season.

Adolescent↗
PubMed2005

The effects of thermal capsular shrinkage on the outcomes of arthroscopic stabilization for primary anterior shoulder instability.

BACKGROUND: The effectiveness of arthroscopic thermal capsulorrhaphy in the prevention of recurrent instability in primary anterior stabilization is undetermined. PURPOSE: To determine if patients with recurrent anterior shoulder instability who have labral repair plus arthroscopic thermal capsulorrhaphy have better outcomes than those with labral repair alone. STUDY DESIGN: Cohort study; Level of evidence, 3. METHOD: There were 72 patients who underwent arthroscopic anterior shoulder stabilization with Suretac II tacks (n = 32) during 1996 to 1999 or with Suretac II tacks plus arthroscopic radiofrequency capsular shrinkage (n = 40) from 1999 to 2002. Standardized patient-determined and examiner-determined outcome measures were obtained preoperatively and at 3, 6, 12, and 24 months postoperatively. Statistical analyses included a Kaplan-Meier analysis of time to recurrent instability. RESULTS: Of the 72 patients, 66 had complete follow-up, including 28 patients treated with the Suretac stabilization and 38 patients with the Suretac plus radiofrequency shrinkage, for a mean follow-up of 58 and 30 months, respectively. All patients had a Bankart lesion. Both groups had similar results with respect to patient-determined and examiner-determined outcome measures. The only adverse outcome was postoperative recurrent instability in 6 of 28 cases in the Suretac group alone and 8 of 38 cases in the Suretac-plus -shrinkage group. Most recurrent instability occurred between 6 and 24 months. Kaplan-Meier analysis for time to recurrent instability showed no differences in the rate of instability recurrence between the 2 groups. CONCLUSION: Arthroscopic thermal capsulorrhaphy neither enhanced nor impaired the outcomes of arthroscopic labral repair with biodegradable tacks in patients with primary recurrent anterior shoulder instability.

Adult↗
PubMed2006

Relationship of chronic ankle instability to muscle activation patterns during the transition from double-leg to single-leg stance.

BACKGROUND: Impaired muscle activation may predispose subjects to develop chronic ankle instability. It has been suggested that impairments are found not only in structures around the injured ankle but also around the more proximal joint complexes. HYPOTHESIS: Subjects with chronic ankle instability were expected to show later onset times for lower limb and trunk muscle activation when compared with control subjects. They were expected to show less variability in muscle activation patterns compared with the control group. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty control subjects and 10 subjects with chronic ankle instability participated in the study. The onset of muscle activity of 14 muscles of the lower limb and trunk was measured during the transition from a double-leg stance position to a single-leg stance position in eyes-open and eyes-closed test conditions. RESULTS: Subjects with chronic ankle instability showed significantly later onset times for the ankle, hip, and hamstring muscles compared with control subjects. They used a similar muscle activation pattern in both test conditions, whereas control subjects adjusted their activation pattern according to the condition. CONCLUSIONS: Differences in muscle activation patterns between subjects with chronic ankle instability and control subjects occur not only around the ankle but also around other joints. Subjects with chronic ankle instability show less variability in muscle activation patterns between test conditions. CLINICAL RELEVANCE: Knowledge of muscle activation patterns in the whole lower limb and trunk in noninjured subjects and the differences found in chronic ankle instability subjects broadens the physical therapy approach to the treatment of chronic ankle instability.

Adult↗
PubMed2005

Chromosomal instability in oral cancer cells.

Chromosomal instability is a common feature of human tumors, including oral cancer. Although a tumor karyotype may remain quite stable over time, chromosomal instability can lead to 'variations on a theme' of a clonal cell population, often with each cell within a tumor possessing a different karyotype. Thus, chromosomal instability appears to be an important acquired feature of tumor cells, since propagation of such a diverse cell population may facilitate evasion of standard therapies. There are several sources of chromosomal instability, although the primary causes appear to be defects in chromosomal segregation, telomere stability, cell-cycle checkpoint regulation, and the repair of DNA damage. Our understanding of the biological basis of chromosomal instability in cancer cells is increasing rapidly, and we are finding that the seemingly unrelated origins of this phenomenon may actually be related through the complex network of cellular signaling pathways. Here, we review the general causes of chromosomal instability in human tumors. Specifically, we address the state of our knowledge regarding chromosomal instability in oral cancer, and discuss various mechanisms that enhance the ability of cancer cells within a tumor to express heterogeneous karyotypes. In addition, we discuss the clinical relevance of factors associated with chromosomal instability as they relate to tumor prognosis and therapy.

Carcinoma, Squamous Cell↗
PubMed2006

Breast tumor copy number aberration phenotypes and genomic instability.

BACKGROUND: Genomic DNA copy number aberrations are frequent in solid tumors, although the underlying causes of chromosomal instability in tumors remain obscure. Genes likely to have genomic instability phenotypes when mutated (e.g. those involved in mitosis, replication, repair, and telomeres) are rarely mutated in chromosomally unstable sporadic tumors, even though such mutations are associated with some heritable cancer prone syndromes. METHODS: We applied array comparative genomic hybridization (CGH) to the analysis of breast tumors. The variation in the levels of genomic instability amongst tumors prompted us to investigate whether alterations in processes/genes involved in maintenance and/or manipulation of the genome were associated with particular types of genomic instability. RESULTS: We discriminated three breast tumor subtypes based on genomic DNA copy number alterations. The subtypes varied with respect to level of genomic instability. We find that shorter telomeres and altered telomere related gene expression are associated with amplification, implicating telomere attrition as a promoter of this type of aberration in breast cancer. On the other hand, the numbers of chromosomal alterations, particularly low level changes, are associated with altered expression of genes in other functional classes (mitosis, cell cycle, DNA replication and repair). Further, although loss of function instability phenotypes have been demonstrated for many of the genes in model systems, we observed enhanced expression of most genes in tumors, indicating that over expression, rather than deficiency underlies instability. CONCLUSION: Many of the genes associated with higher frequency of copy number aberrations are direct targets of E2F, supporting the hypothesis that deregulation of the Rb pathway is a major contributor to chromosomal instability in breast tumors. These observations are consistent with failure to find mutations in sporadic tumors in genes that have roles in maintenance or manipulation of the genome.

Adult↗
PubMed1991

Contralateral shoulder instability following anterior repair. An epidemiological investigation.

We reviewed 188 patients at one to 20 years (mean 9.5) after surgery for anterior shoulder instability. Twenty-one had shown bilateral instability at the time of surgery, and 26 of the remaining 167 subsequently developed instability of the contralateral shoulder, giving an overall incidence of 24% bilateral involvement. Fourteen of these patients ultimately required bilateral surgery. The onset of contralateral instability was at one month to 15 years (mean 5.7 years) after anterior repair of the operated shoulder, the cumulative incidence increasing with time (p less than 0.01). The incidence was significantly higher in those under 15 years at the time of initial dislocation or under 18 at the time of surgery. One-half of the patients with contralateral instability had signs of posterior instability at follow-up. Other predisposing factors included having sustained the initial injury to the operated shoulder as a result of minimal trauma, and persistence of a sensation of instability in the operated shoulder. Factors which were not statistically significant included sex, dominant side, athletic activity, work history, and whether the initial surgery was for recurrent subluxations or dislocations. The high prevalence of bilateral shoulder instability suggests an intrinsic abnormality such as capsular and ligamentous laxity or muscle imbalance and warrants further investigations.

Adolescent↗
PubMed2000

Operative results of the inferior capsular shift procedure for multidirectional instability of the shoulder.

BACKGROUND: Neer and Foster previously described the inferior capsular shift procedure for treating multidirectional instability of the shoulder and reported preliminary results that were quite satisfactory. The purpose of our study was to perform a longer-term follow-up evaluation of the efficacy of the inferior capsular shift procedure for treating multidirectional instability of the shoulder. METHODS: An inferior capsular shift procedure was used to treat multidirectional instability of the shoulder in forty-nine patients (fifty-two shoulders). All patients had failed to respond to an exercise program. In this series, the operative approach (anterior or posterior) was based on the major direction of the instability, as determined by the preoperative history and physical examination and as verified by examination with the patient under anesthesia. In all of the patients, the inferior capsular shift was the primary attempt at operative stabilization. The repair consisted of a lateral-side (or humeral-side) shift of the capsule to reduce capsular redundancy and, when necessary, a reattachment of the avulsed labrum to the anteroinferior aspect of the glenoid. RESULTS: A redundant capsular pouch was seen in all of the shoulders in this series. In addition, detachment of the anteroinferior aspect of the labrum was found in ten shoulders and an anterior fracture of the glenoid rim was seen in two shoulders. At an average of sixty-one months (range, twenty-four to 132 months), results were available for forty-nine shoulders (forty-six patients). Thirty shoulders (61 percent) had an excellent overall result, sixteen (33 percent) had a good result, one (2 percent) had a fair result, and two (4 percent) had a poor result. Forty-seven (96 percent) of the forty-nine shoulders remained stable at the time of follow-up. Two of the thirty-four shoulders that had been repaired through an anterior approach began to subluxate anteroinferiorly again. None of the fifteen shoulders that had been repaired through a posterior approach had recurrent instability. Full function, including the ability to perform strenuous manual tasks, was restored to forty-five shoulders (92 percent). A return to sports was possible after thirty-one (86 percent) of the thirty-six procedures done in athletes; however, a return to the premorbid level of participation was possible after only twenty-five (69 percent) of the thirty-six procedures. CONCLUSIONS: The results in this series demonstrate the efficacy and the durability of the results of the inferior capsular shift procedure for the treatment of shoulders with multidirectional instability. The procedure directly addresses the major pathological feature - a redundant joint capsule. Similar results were seen with either an anterior or a posterior approach, and we continue to approach shoulders with multidirectional instability on the side of greatest instability. A postoperative brace was reserved for patients in whom a posterior approach had been used or in whom an anterior approach had involved extensive posterior capsular dissection (ten of the thirty-four shoulders treated with the anterior approach).

Adolescent↗