Reconstruction of the antero-superior shoulder capsule with the subscapularis tendon: A case report

A 14-year-old boy presented with recurrent, anteroinferior, and multidirectional instability of his dominant shoulder. Examination with the patient under anesthesia demonstrated marked anterior and inferior translation when drawer testing was performed in adduction; however, abduction of the shoulder reduced the magnitude of humeral head translation in both these directions. Arthroscopy and open surgical dissection revealed the absence of any capsuloligamentous structures above the anterior band of the inferior glenohumeral ligament complex. This superior capsular defect could not be closed by a capsular shift procedure; therefore it was reconstructed with a portion of the subscapularis tendon. This case provides a clinical correlation of capsular anatomy with laxity on drawer testing. The glenohumeral laxity documented on examination with the patient under anesthesia supports experimental ligament-cutting studies that suggest the inferior glenohumeral ligament complex is the important stabilizer in abduction, whereas the superior and middle glenohumeral ligaments are more important in adduction.