Does Capsuloplasty Reduce External Rotation After Coracoid Impingement?

Does Capsuloplasty Reduce External Rotation After Coracoid Impingement? A Randomized Controlled Trial

The coracoid anchor (Latarjet procedure) is the gold standard technique for treating recurrent anterior shoulder instability. Despite excellent postoperative stability, a reduction in external rotation has been reported, which can affect function, glenohumeral kinematics, and return to sports, particularly among athletes in combat and contact sports.

The combination of an anterior capsuloplasty with the coracoid buttress is performed inconsistently among surgeons, with no consensus; the capsular repair techniques associated with the Latarjet procedure vary widely among teams. Some teams routinely perform capsular repair to enhance stability and reposition the capsule on the glenoid rim, while others consider it non-essential and potentially responsible for further limiting external rotation.

To date, there are few studies specifically evaluating the impact of capsuloplasty on joint range of motion beyond the end-stop, and the available results remain contradictory. In 2023, the team of Kim et al. suggested that the Latarjet technique without capsular repair resulted in good restoration of laxity and good clinical outcomes, with less early postoperative limitation of external rotation than that observed with the same technique combined with capsular repair. Nevertheless, at 1 year, there was no significant deficit in external rotation between the two groups.

A prospective randomized comparative analysis will determine whether the addition of capsuloplasty significantly alters ranges of motion, given identical surgical and rehabilitation protocols. The results could clarify the indications for this procedure, optimize surgical practices, and improve recommendations for the management of shoulder instability.

Study Overview

• Status: Not yet recruiting
• Conditions: Shoulder Anterior Latarjet Instability
• Intervention / Treatment: Procedure: Open coracoid impingement repair without capsuloplasty; Procedure: Open coracoid impingement repair with capsuloplasty

• Study Type: Interventional
• Enrollment (Estimated): 104
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Marion Mandon, PhD; Phone Number: +33 6 78 27 76 72; Email: mmandon@vivalto-sante.com

Study Locations

• France
  • Mérignac, France, 33700
    • Clinique du Sport
    • Contact: Marion Mandon, PhD; Phone Number: +33 6 78 27 76 72; Email: mmandon@vivalto-sante.com
    • Principal Investigator: Florent Baldairon, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Standard indications for surgery (glenoid bone loss, advanced Hill-Sachs lesion, failed Bankart repair, contact sports, etc.).
• Shoulder not previously operated on

Exclusion Criteria:

• Significant associated rotator cuff pathology, associated SLAP lesion
• Advanced glenohumeral osteoarthritis.
• Recurrent impingement, history of shoulder surgery
• Presence of severe external rotation deficit of the shoulder prior to surgery

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Open coracoid impingement repair without capsuloplasty	Procedure: Open coracoid impingement repair without capsuloplasty; All patients undergo an open coracoid osteotomy performed using the center's standard technique. The procedure is performed under general anesthesia combined with an interscalene block. The patient is positioned in a semi-sitting position. The approach is delto-pectoral; an osteotomy of the coracoid process is performed after detachment of the acromiocoracoid ligament and the pectoralis minor tendon. A tunnel is created through the subscapularis muscle, followed by a horizontal capsulotomy with placement of guide sutures on both capsular margins. The glenoid is re-contoured, and the stop is then fixed to the glenoid with two screws (Asnis-Stryker, 3.5 mm in diameter).
Experimental: Open coracoid impingement repair with standardized anterior capsuloplasty	Procedure: Open coracoid impingement repair with capsuloplasty; All patients undergo an open coracoid osteotomy performed using the center's standard technique. The procedure is performed under general anesthesia combined with an interscalene block. The patient is positioned in a semi-sitting position. The approach is delto-pectoral; an osteotomy of the coracoid process is performed after detachment of the acromiocoracoid ligament and the pectoralis minor tendon. A tunnel is created through the subscapularis muscle, followed by a horizontal capsulotomy with placement of guide sutures on both capsular margins. The glenoid is re-contoured, and the stop is then fixed to the glenoid with two screws (Asnis-Stryker, 3.5 mm in diameter). Anterior capsuloplasty is performed using a predefined, reproducible technique: horizontal, with an anchor.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Range of external rotation	arm against the body and in 90° abduction : measure of range of external rotation	12 months after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recurrence of instability		12 months after surgery
Rowe score	Score with 4 parts : mobility (10 points); function (50 points); pain (10 points); stability (30 points) Each part is scored with a Likert scale (3 or 4 points). Total scoring is / 100 points.	12 months after surgery

Collaborators and Investigators

• Sponsor: Clinique du Sport, Bordeaux Mérignac
• Investigators: Principal Investigator: Florent Baldairon, MD, Clinique du Sport

Study record dates

Study Major Dates

• Study Start (Estimated): May 2, 2026
• Primary Completion (Estimated): October 31, 2028
• Study Completion (Estimated): December 31, 2028

Study Registration Dates

• First Submitted: April 3, 2026
• First Submitted That Met QC Criteria: April 3, 2026
• First Posted (Actual): April 9, 2026

Study Record Updates

• Last Update Posted (Actual): April 9, 2026
• Last Update Submitted That Met QC Criteria: April 3, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: instability; Latarjet; dislocation
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Wounds and Injuries; Joint Diseases; Joint Dislocations
• Other Study ID Numbers: 2025-65-SBM

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No