Capsular Repair Matters for Residual Micromotion After Latarjet. An Externally Controlled Trial from the La Tour Group

Alaa Elsenbsy; Caecilia Charbonnier; Valérie Juillard; Sylvain Chague; Jeanni Zbinden; Philippe Collin; Ahmed M. Ahmed; Alexandre Lädermann

Abstract

Background: Even though surgery is commonly used to treat glenohumeral instability, there is no evidence that such treatment effectively corrects glenohumeral translation.Purpose: This study aimed to analyze the effect of a new capsular reconstruction on residual micromotion after Latarjet procedure.Methods: Bilateral glenohumeral translation was assessed in nine patients preoperatively and one year postoperatively following Latarjet with a new capsular reconstruction (treatment group). Translation was measured using optical motion capture, computer tomography (CT) reconstructions, and 3- dimensional (3D) simulation. The results were compared with a previous cohort of eleven patients operated with traditional capsular reconstruction (control group).Results: A total of 20 patients were included in this study. The median follow-up duration was 12 months (range, 12 to 16 months). A statistically significant improvement in shoulder pain and function was reported postoperatively in treatment and control groups. No patients reported recurrent dislocation during the study period or had a positive apprehension sign at the final follow-up. The preoperative to postoperative range of motion (ROM) improvement was more pronounced in the treatment group than the control group with respect to shoulder flexion (P = .001), abduction (P = .041), and internal rotation with elbow at side (P = .035) for thoracohumeral motion, and shoulder abduction (P = .037), and internal rotation at 90/90 position (P = .006) for glenohumeral motion. The treatment group also exhibited more significant preoperative to postoperative reduction in anteroposterior translation during shoulder internal and external rotation with the elbow at the side (P = .018 and .016, respectively).Conclusion: This study demonstrated that a new type of capsulolabral reconstruction during the Latarjet procedure could reduce residual anteroposterior micromotion compared with a previously used technique, without compromising postoperative ROM. Although no differences in clinical apprehension were observed between groups, these biomechanical findings support the hypothesis that careful capsular management may influence postoperative shoulder stability. Whether this effect translates into long-term clinical benefit remains to be established in larger studies with extended follow-up.What this study adds: This study shows that capsulolabral reconstruction during the Latarjet procedure reduces residual glenohumeral micromotion without limiting postoperative range of motion. Patient-specific in vivo kinematic analysis suggests that refined capsular management can restore near-physiological shoulder stability despite similar short-term clinical outcomes.Potential impacts on research, practice or policy: The findings suggest a shift from simply preventing recurrent dislocation toward optimizing postoperative stability after Latarjet surgery. Meticulous capsulolabral reconstruction may reduce residual microinstability associated with persistent apprehension or degenerative changes. The study also supports the use of advanced kinematic assessment and provides biomechanical justification for labral and capsular preservation, with longer-term studies needed to confirm clinical benefit.Study Design: Prospective Externally Controlled TrialLevel of Evidence: Level II (prospective comparative study)Keywords: Glenohumeral stabilization; Subtle or minor instability; Unstable painful shoulder; Apprehension; Dislocation; Kinematics modeling; Biomechanics; Motion capture; 3D simulation; Computer tomography (CT).https://doi.org/10.70885/hmsj.2026.01.001

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