Summary

Utilizing the Arthroscopic West Point Load Shift Technique before, during, and after arthroscopic anchor placement can help achieve greater restoration of glenohumeral capsuloligamentous balance and stability.

Abstract

Traumatic anterior shoulder instability may present as a transient instability event (subluxation) or complete glenohumeral disassociation (dislocation). Surgical stabilization of anterior shoulder instability is the preferred treatment in young athletes to prevent recurrence. Physical examination determines the degree and direction of instability as well as associated laxity. Siliman and Hawkins described the load shift test to determine the direction and degree the humeral head translates relative to glenoid in the anterior and posterior directions. The accuracy and utility of these physical exam tests are limited by patient apprehension, guarding, operator technique, and patient anatomy making it difficult to determine the degree of instability. The purpose of this article is to describe an intraoperative arthroscopic technique for direct visualization of the glenohumeral joint from an intraarticular 50-yard line view. This technique allows for a direct intraoperative instability examination and direct assessment of the anterior, posterior and inferior glenohumeral joint laxity before and after stabilization. The Arthroscopic West Point Load Shift technique when viewing from a 50-yard line intraarticular view is useful to identify isolated anterior, posterior or combined anterior-posterior instability, guide anchor placement, and titrate capsuloligamentous structures in arthroscopic stabilization surgery.