Open Anterior Capsular Reconstruction of the Shoulder for Chronic Instability Using a Tibialis Anterior Allograft

Abstract

Stability of the shoulder comes from a complex interaction of various factors. Dynamic and static components are provided by soft tissue and bony structures creating joint stability. Recurrent anterior glenohumeral instability can be a difficult problem because there is a wide variety of possible pathologies. To address the problem, a precise analysis of the etiology of instability is necessary. Soft tissue insufficiency, osseous deficiency, and a combination of both have to be considered as etiologic factors. This article focuses on the treatment of recurrent anterior glenohumeral instability secondary to soft tissue insufficiency-especially in patients who have undergone multiple ineffective surgeries before and have soft tissue disorders. Therefore, we present a technique for anterior capsulolabral reconstruction with a tibialis anterior tendon allograft. The main structures that are reconstructed by the allograft are the anterior labrum, the middle glenohumeral ligament, and the anterior band of the inferior glenohumeral ligament. Because of the complexity of the reconstruction, the technique is performed as open surgery, which allows precise placement and tensioning of the allograft tendon. The postoperative protocol requires placing the arm in a sling for 6 weeks and cautious physiotherapy. The results of this salvage procedure are highly satisfactory.