title: Iliotibial band reconstruction for treatment of glenohumeral instability associated with irreparable capsular deficiency.
abstract: The surgical management of patients with recurrent anterior instability after failed surgery can be complicated by the loss of capsular tissue and, in some cases, irreparable tears of the subscapularis tendon. We describe a new surgical technique for reconstruction of the capsular ligaments using the iliotibial band (ITB) to reconstruct deficient capsular tissues, and we report the results of 7 patients. All patients had prior surgery, with a mean of 2.2 procedures, and recurrent instability as the primary indication for their index and revision surgeries. After ITB reconstruction, the patients demonstrated significant improvement in their American Shoulder and Elbow Surgeons (ASES) score (P =.0004), and no patient had any persistent symptoms of instability. Physiologic range of motion and function were maintained. We would recommend our method of ITB reconstruction for patients with instability and capsular deficiency after failed surgery and believe that this procedure has advantages over those previously described. Capsular deficiency and persistent instability after prior surgery can occur after prior open or arthroscopic surgery. Capsular deficiency has been described after thermal capsulorrhaphy and is thought to represent excessive thermal injury and tissue necrosis. After open capsulorrhaphy, capsular deficiency can be associated with subscapularis tendon deficiency.(4,6-8,12,13) Capsular deficiency occurring after either open or arthroscopic surgery presents a difficult surgical challenge. The purpose of this case series is to evaluate our experience in the surgical management of recurrent glenohumeral instability after surgery initially performed for treatment of glenohumeral instability that failed and is associated with irreparable tears of the subscapularis and capsular deficiency. The primary objectives of this study are to describe the surgical technique for capsular reconstruction with ITB and to report the clinical results in 7 patients.
authors.affiliation: Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Iannotti
authors.forename: John
authors.initials: J
authors.lastname: Antoniou
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Williams
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Ramsey
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017746:Joint Capsule / Q000503:physiopathology / Q000601:surgery*; D007593:Joint Instability / Q000175:diagnosis* / Q000601:surgery*; D008023:Ligaments, Articular / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D012783:Shoulder Dislocation / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome