Open Capsulorrhaphy With Capsular Shift and Open Coracohumeral Ligament Reconstruction for Chronic Recurrent...

This case features the surgical reconstruction of the coracohumeral ligament (CHL) in conjunction with open capsulorrhaphy and capsular shift for the management of chronic, recurrent, multidirectional shoulder instability (MDI). While there is a paucity of existing literature examining the clinical outcomes of this technique, biomechanical studies have implied its potential to restore stability. This procedure may be of particular benefit to patients who have failed previous conservative management and/or attempts at surgical stabilization, as well as those with severe joint hyperlaxity or connective tissue disorders.

This patient failed extensive physical therapy, as well as previous arthroscopic labral repair and capsulorrhaphy of the shoulder, necessitating further intervention to achieve the desired level of activity and function.

After positioning the patient in a modified beach-chair position, a deltopectoral approach is utilized. Next, a subscapularis split is performed, followed by a T-capsulotomy. A capsular shift is performed. Then, the semitendinosus allograft is docked into the lateral and posterior aspect of the coracoid. After placing the arm into neutral forward flexion with 40° of external rotation and 30° of abduction, the graft is secured onto the humerus.

Cadaveric biomechanical studies have demonstrated an increased resistance to translation after imbrication of the CHL. However, no clinical outcome studies have been reported to date using the technique described in this video. In our patient, stabilization of the shoulder joint was achieved. Reduction of the sulcus sign and decreased degree/frequency of subjective symptoms of instability were reported in the early postoperative period. This patient reported no pain, had negative apprehension and relocation tests, and a near-full range of motion at 7 months postoperatively, although external rotation was moderately decreased.

In the setting of recurrent MDI refractory to conservative or previous surgical interventions, reconstruction of the CHL may be considered as an adjunct to other operative stabilization procedures. Further research is needed to determine clinical outcomes.

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