“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.

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