A soft tissue attempt to stabilize the multiply operated glenohumeral joint with multidirectional instability

Treating patients with multidirectional instability who have had multiple failed stabilization procedures is a challenging problem. These patients have disability from instability and pain. Final treatment may be glenohumeral narthrodesis. We report on the results of a soft tissue operation for treatment of multidirectional instability in multiply operated shoulders. Since 1994, 28 patients have had what we term the kitchen sink operation for treatment of refractory multidirectional instability. After exclusion of patients with collagen abnormality, 10 patients who had at least three previous stabilizations were identified with recalcitrant multidirectional instability. The kitchen sink operation encompasses a humeral-based inferior capsular shift, Nicola biceps tenodesis, and coracohumeral ligament and rotator interval augmentation and/or reconstruction. All patients were immobilized for 8 weeks postoperatively. Minimum clinical and radiographic followup was 2 years (range, 2-6 years). Preoperatively, all patients had incapacitating pain and instability. Postoperatively, five patients (50%) had significant improvement of pain, and nine patients (90%) had successful reduction of instability. Four of the five patients with persistent disabling pain needed glenohumeral fusions. The kitchen sink operation is a final attempt to stabilize the shoulder with multidirectional instability. This procedure reduces instability (especially inferior) associated with multidirectional instability. However, pain remains unremitting in 50% of patients, therefore a glenohumeral arthrodesis may be needed as a last option.