Open Inferior Capsular Shift for Multidirectional Shoulder Instability in Adolescents with Generalized Ligamentous Hyperlaxity or Ehlers-Danlos Syndrome | oneedsvoice

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Open Inferior Capsular Shift for Multidirectional Shoulder Instability in Adolescents with Generalized Ligamentous Hyperlaxity or Ehlers-Danlos Syndrome

key information

source: Journal of Shoulder and Elbow Surgery

year: 2016

authors: Vavken P, Tepolt FA, Kocher MS

summary/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.
DISCUSSION:
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.

organisation: Boston Children's Hospital; Harvard Medical School; Alpha Clinic Zurich

DOI: 10.1016/j.jse.2015.10.010

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