Two-Year Outcomes of Open Shoulder Anterior Capsular Reconstruction for Instability From Severe Capsular Deficiency

• Published in: Arthroscopy Vol. 28; no. 1; pp. 43 - 51
• Main Authors: Dewing, Christopher B., M.D, Horan, Marilee P., M.P.H, Millett, Peter J., M.D., M.Sc
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2012; Elsevier
• Subjects: Adolescent; Adult; Arthroscopy; Biological and medical sciences; Cohort Studies; Diseases of the osteoarticular system; Endoscopy; Female; Follow-Up Studies; Humans; Investigative techniques, diagnostic techniques (general aspects); Joint Capsule - pathology; Joint Capsule - surgery; Joint Instability - etiology; Joint Instability - physiopathology; Joint Instability - surgery; Juxtaarticular diseases. Extraarticular rhumatism; Magnetic Resonance Imaging - methods; Male; Medical sciences; Orthopedic surgery; Orthopedics; Pain Measurement; Range of Motion, Articular - physiology; Reconstructive Surgical Procedures - methods; Recovery of Function; Recurrence; Retrospective Studies; Risk Assessment; Severity of Illness Index; Shoulder Dislocation - complications; Shoulder Dislocation - diagnosis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tissue Transplantation - methods; Transplantation, Homologous; Treatment Outcome; Young Adult; Shoulder instability; Arthroscopy; Orthopedic surgery; Prognosis; Treatment; Deficiency; Endoscopy
• ISSN: 0749-8063; 1526-3231
• DOI: 10.1016/j.arthro.2011.07.002

Purpose To document outcomes after anterior capsulolabral reconstruction for recurrent shoulder instability in 15 patients (20 shoulders) who have had multiple failed stabilizations or collagen disorders. Methods Twenty shoulders with recurrent instability underwent revision stabilization with allograft reconstruction of anterior capsulolabral structures, which re-creates the labrum and capsular ligaments. The patients comprised 3 men and 12 women (mean age, 26 years [range, 18 to 38 years]) in whom multiple prior repairs failed and who had disability from continued pain and instability. Patients could choose to undergo either arthrodesis or salvage allograft reconstruction or to live with permanent disability. Of the patients, 5 had Ehlers-Danlos syndrome whereas 10 had hyperlaxity syndromes without genetic confirmation. Failure was defined as further instability surgery. Pain, shoulder function, instability (dislocations/subluxation), and American Shoulder and Elbow Surgeons scores were documented. Results At follow-up, 9 of 20 shoulders (45%) remained stable. Recurrent instability was reported in 5 shoulders (25%), but the patients chose not to undergo further surgery. In the 14 shoulders without further stabilization (nonfailures), the mean American Shoulder and Elbow Surgeons score increased 43 points at a mean of 3.8 years (range, 2 to 6 years) postoperatively ( P < .05). Mean satisfaction with outcome in nonfailures was 7 of 10 points (range, 1 to 10). Six shoulders failed by progressing to instability surgery at a mean of 8.6 months (range, 2.8 to 24 months). In the 6 shoulders that failed, the mean number of prior surgeries was 8 (range, 3 to 15) compared with a mean of 4 prior surgeries (range, 1 to 16) for the 9 nonfailures. Conclusions Treating patients in whom multiple stabilizations have failed remains challenging. In our series 9 shoulders (45%) remained completely stable at 3.8 years. Recurrent instability (3 reinjuries) requiring further stabilization occurred in 6 (30%). Subsequent treatment for non-instability reasons was performed in 3 (15%). Instability was reported but revision surgery was not performed in 5 (25%). In 8 nonfailures (64%), the patients were highly satisfied with their surgical outcomes. Our results support this salvage procedure as a viable alternative to arthrodesis in young patients with end-stage shoulder instability or collagen disorders. Level of Evidence Level IV, therapeutic case series.