Achilles Allograft Stabilization of the Shoulder in Refractory Multidirectional Glenohumeral Instability

Abstract

Treatment of multidirectional glenohumeral instability is a challenge for the orthopaedic surgeon and generally involves nonoperative therapy as the first line of treatment. In patients who fail conservative treatment, successful results can be achieved with open surgery. More recently, there has been increased interest in the use of arthroscopic techniques, including capsular plication, capsular shifting, and thermal modification with the use of laser or radiofrequency devices. Reports have indicated that these arthroscopic techniques can offer good short-term results. However, with longer-term outcome studies showing high long-term failure rates regardless of method, it is necessary to explore other procedural options of providing these patients with some form of relief. We present a salvage procedure involving Achilles tendon allograft reconstruction of the glenohumeral ligament complex in patients with severe multidirectional shoulder instability (most of whom also exhibited an underlying connective tissue disorder) who had previous failed attempts at stabilization using open soft tissue capsular shifting techniques. Although the long-term failure rate of our procedure was high, it did offer significant short-term relief and stability to most patients who stated that they would have the procedure again rather than undergo arthrodesis or replacement.