Arthroscopic labral repair and capsular shift of the glenohumeral joint: technical pearls for a multiple pleated plication through a single working portal.

The arthroscopic treatment of shoulder instability is becoming increasingly popular with recent clinical studies showing similar success rates comparable to open procedures. These improved success rates are likely due to a better understanding of the pathoanatomy of shoulder instability and addressing all injured structures including labral tears and capsular injury and stretching. I present a new arthroscopic technique for shoulder stabilization that makes use of already known techniques by sequentially repairing the labral tear and performing a capsular shift through multiple, separate pleated plications through a single working portal. This technique allows for an anatomic labral repair with a capsular shift as large as desired by performing as many additional tucks of capsule for plication as needed, comparable to open techniques with less surrounding tissue trauma. This technique is actually easier than more traditional arthroscopic methods, and the multiple pleats may provide a load-sharing effect dispersed through each pleat, which may decrease the risk of load failure.