Posterior Glenohumeral Capsular Reconstruction Using an Acellular Dermal Allograft

Abstract

Posterior shoulder instability is an uncommon and challenging cause of shoulder pain and dysfunction. Surgical management has less reliable results and higher failure rates compared with techniques for anterior shoulder instability. The presence of generalized ligamentous laxity further complicates options for surgical management. If primary capsulolabral repair fails, controversy exists as to the optimal revision procedure. This technical description and video present an arthroscopic technique for reconstruction of the posterior glenohumeral capsule with an acellular dermal allograft to treat posterior instability in a patient with Ehlers-Danlos syndrome and a previously failed posterior capsular plication.

Posterior Glenohumeral Capsular Reconstruction With Modified McLaughlin for Chronic Locked Posterior Dislocation

“…The use of an acellular dermal allograft has been described previously for the reconstruction of the superior capsule in chronic massive rotator cuff tears, for the reconstruction of the anterior capsule for failed anterior shoulder instability,16, 17, 18 and more recently for the reconstruction of the posterior capsule in a patient with Ehlers–Danlos syndrome 19 . This technique gives the surgeon another option before arthroplasty for capsulolabral repair in the setting of deficient or absent tissue.…”

Arthroscopic Posterior Glenohumeral Capsular Augmentation With Gracilis Tendon Allograft

“…Described posterior-based soft-tissue procedures are fewer but have included simultaneous anterior and posterior reconstruction with Achilles allograft 21 . Recently, an arthroscopic dermal allograft reconstruction procedure was described, 29 which is similar in concept to currently used superior capsular reconstruction techniques 30 …”

Innovative Approaches in the Management of Shoulder Instability: Current Concept Review

“…Increased operative time in cases of graft suture entanglement, difficult technique and increased costs are the disadvantages of the arthroscopic ACR procedure [52]. Careful suture management and use of 3D models in pre-operative planning for graft sizes can decrease the chances of these complications [52,54].…”

“…It can also be used to assess the glenoid bone loss and for measurements of allograft in capsular reconstruction for anterior and posterior instability. [54] In our institute, we routinely use 3D models in the pre-operative planning for AAGR and ACR procedures (Fig. 8) [54].…”

“…[54] In our institute, we routinely use 3D models in the pre-operative planning for AAGR and ACR procedures (Fig. 8) [54]. We believe that a 3D model is a useful aid in preoperative and intraoperative planning to help improve accuracy and decrease operative time.…”