Open reconstruction of the anterior glenohumeral capsulolabral structures with tendon allograft in chronic shoulder instability

Abstract

The presented technique aims at reconstruction of the anterior capsulolabral structures of the glenohumeral joint in the case of recurrent severe instability after multiple surgical attempts to achieve stabilization. The procedure is indicated for patients experiencing significant lifestyle-limiting recurrent shoulder instability with etiologic soft tissue deficiency. Bony defects or abnormalities can not be addressed with the index technique. A standard deltopectoral approach with lateral incision of the subscapularis tendon is used for exposure to prepare the anterior glenoid rim. Suture anchors placed at the glenoid rim are used for fixation of a tibialis anterior tendon allograft, which is tightened and fixed to the bone on the humerus with intereference screws. This recreates the anterior labrum and the middle glenohumeral ligament and the anterior band of the inferior glenohumeral ligament. Intraosseuos repair of the subscapularis tendon and reinforcement of the capsular structures by sewing the capsule into the allograft complete the procedure. Postoperatively, the use of an arm sling is recommended for 6 weeks with limited physical exercises to avoid stretching the tightened and reconstructed soft tissue structures. The results of this salvage procedure in this highly challenging population have been satisfying. Twenty shoulders in 15 patients were operated (3 male, 12 female, average age 26 years) from July 2002 to April 2008. In 14 of the 20 (70%) shoulders, adequate stability was gained and no further surgery was required. The average ASES score increased by 37 points at a mean follow-up of 37 months (range 22-74 months). Mean satisfaction with surgical outcomes was 6.5 points (max. 10). In 5 patients, 6 shoulders were considered failures and required further surgical treatment after a mean of 9 months (range 3-24 months).