Le but de ce travail était d’évaluer rétrospectivement les résultats d’une série monocentrique de joueurs de rugby à XV, opérés d’une instabilité antérieure traumatique de l’épaule avec réparation capsulaire sélective, au recul minimum de cinq ans. Trente-trois joueurs (35 épaules) ont été revus cliniquement ou interrogés par téléphone. Il s’agissait de joueurs engagés en compétition régionale dans 61 % des cas. L’âge au moment de l’intervention était de 21 ans (16–34). Des signes d’hyperlaxité capsulaire étaient présents pour 16 épaules (46 %) et une lésion osseuse de passage sur la glène pour 14 (40 %). Vingt-trois épaules (65 %) présentaient une désinsertion du labrum antéro-inférieur et ont eu une réinsertion par ancres. Douze épaules présentaient une distention capsulaire isolée. Une capsuloplastie a été réalisée selon la technique de Neer pour 33 épaules, en complément de la réinsertion labrale pour 21 d’entre elles. Quatre-vingt-dix-sept pour cent des patients ont repris le rugby au même niveau. Au recul moyen de 82 mois (60–120), six épaules (17 %) ont présenté un nouvel épisode d’instabilité. Selon les scores de Rowe et Duplay-Walch, les résultats étaient bons ou excellents pour, respectivement 86 et 80 % des épaules. Il existait une restriction moyenne de 6,2° de la rotation externe coude au corps et une diminution moyenne de la force du muscle subscapulaire de 2,05kg par rapport au côté sain. Soixante-dix-sept pour cent des épaules avaient peu ou pas d’arthrose. Le taux de satisfaction atteignait 88 %.

In rugby players, 9 to 11% of injuries involve shoulder trauma. Anterior dislocation is one of the most severe accidents affecting the upper limb; recurrent dislocation, observed in more than 60%, appears to be related to the characteristic mechanism of injury in this sport (tackling). Surgical treatment for this instability is a bone block or capsulolabral repair. The purpose of this work was to evaluate outcome with minimum five-years follow-up after treatment by selective capsule repair in a homogeneous series of rugby players.

Between 1995 and 2001, 31 rugby players were reviewed at mean 82 months (range: 60 to 120 months) follow-up. Sixty-one percent were regional-level players. A tackle was involved in the instability accidents for half of the players. Age at surgery was 21 years (range: 16 to 34), on average 4.44 years (range: 2 to 20) after the instability accident. Signs of capsule hyperlaxity were noted in 16 shoulders (46%). Dislocation was noted in 27 shoulders, subluxation in five. Chronic pain and instability were noted for three shoulders. Disinsertion of the anteroinferior labrum was noted in 23 shoulders (65%) and was repaired with two, three or four anchors. Isolated capsule distension was observed in twelve shoulders. Neer capsuloplasty was performed on 33 shoulders, with complementary labral reinsertion for 21 of them.

Ninety-seven percent of the patients were playing rugby again after surgery, the longest delay being one year after the operation. A new episode of instability after major trauma was observed in six shoulders (17%), on average 3.8 years (range: 0.5 to 6) after the operation. Isolated capsule repair had the poorest prognosis (p=0.04). Compared with the contralateral side, external rotation decreased on average 6.2° (elbow to chest) and 3.4° at 90° abduction. Subscapular muscle force decreased on average 2.05kg. The Rowe and Duplay-Walch scores were good or excellent for 86% and 80% of shoulders, respectively. Patient satisfaction was 88%. According to Samilson, radiographic degeneration was noted in 32% of shoulders, with stage 1 osteoarthritis in 45% and stage 2 in 23%.

Young age appears to be a major factor, predictive of recurrence after a first instability accident; the type of sport would only be indirectly involved. Nevertheless, for patients playing this type of contact sports, the appropriateness of surgical stabilization can be debated; arthroscopic anatomic methods have not yet yielded results equivalent to open surgery. The results in this series are similar to those found elsewhere in the literature, but with a follow-up longer than generally reported. Anatomic reconstruction of anterior stability elements enables these patients to resume their contact sport at an equivalent level with restored joint motion.