Anterior capsular shift volume reduction: an in vitro comparison of 3 techniques

The anterior capsular shift is a well-established procedure for correction of capsular redundancy. Several different techniques have been developed to reduce capsular volume via a shift or capsulorrhaphy. The purpose of this study was to compare volume reduction objectively among 3 popular capsular shift techniques. Twenty-four fresh-frozen human cadaver shoulders were assigned to one of three groups: a lateral (humeral)–based T-capsular shift (group A), a medial (glenoid)–based T-capsular shift (group B), or a central vertical capsular shift (group C). Initial capsular volume was measured by repeated injection of a viscous fatty acid sulfate solution and recorded for each specimen. A predetermined capsular shift procedure was performed on each cadaver, and repeated measurements were made. All 3 procedures resulted in a significant reduction in capsular volume. The lateral (humeral)–based T-capsular shift resulted in the most reduction (48.9%). This reduction was statistically greater than for the glenoid-based shift (36.8% volume reduction) and approached statistical significance for the vertical shift (40.3% volume reduction, P = .12). Repeated measurements confirmed that the injection technique was valid and reproducible. The lateral (humeral)–based capsular shift results in the most volume reduction and should be considered the preferred procedure for patients with excessive capsular redundancy.