title: Open inferior capsular shift for multidirectional shoulder instability in adolescents with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome.
abstract: BACKGROUND
  The objective of this study was to assess the outcome of open inferior capsular shift for multidirectional shoulder instability in patients with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome.
  
  
  METHODS
  Data were obtained for 18 open inferior capsular shift surgeries in 15 adolescent patients with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome with a mean follow-up of 7.5 years. End points were subjective clinical outcome (pain, stability, satisfaction, return to sport), objective clinical outcome (recurrence, complications), and functional outcome scores (American Shoulder and Elbow Surgeons, 11-item version of the Disabilities of Arm, Shoulder and Hand).
  
  
  RESULTS
  Thirteen patients (87%) reported improved pain and stability and were satisfied with the procedure. Nine patients (64%) were able to return to sports. One patient (7%) was dissatisfied with continuous pain and recurrent instability and considered a surgical failure. Seven patients (47%) reported no further episodes of instability. The mean American Shoulder and Elbow Surgeons score at a mean of 7.5 years of follow-up was 88 ± 10 points, and the mean score for the 11-item version of the Disabilities of Arm, Shoulder and Hand was 14 ± 14 points.
  
  
  CONCLUSIONS
  The management of multidirectional shoulder instability in adolescent patients with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome is challenging. Open inferior capsular shift results in improvement in subjective and objective shoulder function and stability in adolescent patients with ligamentous hyperlaxity or Ehlers-Danlos who have failed nonoperative treatment. We found no effect of the recalled number of prior dislocations, laterality, and type of hyperlaxity on subjective and objective clinical outcomes.
  
  
  METHODS
  Level IV; Case Series; Treatment Study.
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA; Alpha Clinic Zurich, Kraftstrasse 29, 8044 Zurich, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Vavken
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Frances A
authors.initials: FA
authors.lastname: Tepolt
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA. Electronic address: mininder.kocher@childrens.harvard.edu.
authors.forename: Mininder S
authors.initials: MS
authors.lastname: Kocher
mesh_terms: D000293:Adolescent; D001182:Arthroscopy / Q000009:adverse effects; D004535:Ehlers-Danlos Syndrome / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017746:Joint Capsule / Q000601:surgery*; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000503:physiopathology / Q000601:surgery; D008297:Male; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ehlers-Danlos syndrome; MDI; hyperlaxity; open shift; pediatric; shoulder instability