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

Authors:

Christopher B Dewing, Marilee P Horan, Peter J Millett

Abstract:

“End-stage” shoulder instability in young patients may be attributed to complex issues of bone loss about the glenohumeral joint, capsular insufficiency, or both. Capsular attrition and insufficiency in this patient population may be attributed to multiple failed prior surgeries, failed postoperative rehabilitation, previous thermal capsulorrhaphy resulting in tissue necrosis, or hereditary collagen disorders. Results of revision stabilization attempts are compromised by inadequate or poor-quality capsular and labral tissue and by potentially undiagnosed connective tissue disorders or abnormalities.

Several surgical techniques, both nonanatomic and anatomic have been described to address the reconstruction of the anterior glenohumeral capsule and ligaments as salvage procedures for end-stage shoulder instability and/or the treatment of instability in patients with collagen disorders. Successful restoration of glenohumeral stability without recurrent dislocation has been documented in 65% to 96% of patients in these series. Optimal allograft/autograft choices, specific methods for graft placement and fixation, and ideal rehabilitation protocols for these reconstructions remain controversial.

The surgical technique for allograft tibialis anterior tendon reconstruction of the main stabilizing structures of the anterior labrum, the middle glenohumeral ligament, and the anterior band of the inferior glenohumeral ligament has been previously published.1 This reconstruction technique allows for precise placement and tensioning of the allograft tendon.

The purpose of our study was to examine the mid-term results of anterior capsulolabral reconstruction with a free soft-tissue tibialis anterior allograft tendon or hamstring autograft for recurrent end-stage instability as a useful salvage procedure in patients with capsular deficiency or pathologic collagen.

For the complete study: Two-Year Outcomes of Open Shoulder Anterior Capsular Reconstruction for Instability From Severe Capsular Deficiency

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

Submit your review
Name:
Email:
Website:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel

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

Authors:

Abstract:

About the Author: Peter Millett, MD