Peebles Liam A, Aman Zachary S, Preuss Fletcher R, Samuelsen Brian T, Zajac Tyler J, Kennedy Mitchell I, Provencher Matthew T
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
University of Virginia School of Medicine, Charlottesville, Virginia, U.S.A.
Arthrosc Tech. 2019 Apr 11;8(5):e459-e464. doi: 10.1016/j.eats.2019.01.002. eCollection 2019 May.
Recurrent multidirectional shoulder instability (MDI) is a challenging clinical problem, particularly in the setting of connective tissue diseases, and there is a distinct lack of literature discussing strategies for operative management of this unique patient group. These patients frequently present with significant glenoid bone loss, patulous and abnormal capsulolabral structures, and a history of multiple failed arthroscopic or open instability procedures. Although the precise treatment algorithm requires tailoring to the individual patient, we have shown successful outcomes in correcting recurrent MDI in the setting of underlying connective tissue disorders by means of a modified T-plasty capsular shift and rotator interval closure in conjunction with distal tibial allograft bony augmentation. The purpose of this Technical Note was to describe a technique that combines a fresh distal tibial allograft for glenoid bony augmentation with a modified T-plasty capsular shift and rotator interval closure for the management of recurrent shoulder MDI in patients presenting with Ehlers-Danlos syndrome or other connective tissue disorders after failed Latarjet stabilization.
复发性多方向肩关节不稳（MDI）是一个具有挑战性的临床问题，尤其是在结缔组织疾病的背景下，并且明显缺乏讨论针对这一独特患者群体的手术治疗策略的文献。这些患者经常出现明显的肩胛盂骨丢失、关节囊盂唇结构松弛和异常，以及多次关节镜或开放手术治疗不稳失败的病史。尽管精确的治疗方案需要根据个体患者进行调整，但我们已经证明，通过改良的T形成形术关节囊移位和旋转间隙闭合联合异体胫骨远端植骨增加骨量，在潜在结缔组织疾病的情况下纠正复发性MDI可取得成功的结果。本技术说明的目的是描述一种技术，该技术将新鲜的异体胫骨远端用于肩胛盂骨量增加，同时结合改良的T形成形术关节囊移位和旋转间隙闭合，用于治疗在Latarjet稳定术失败后出现埃勒斯-当洛综合征或其他结缔组织疾病的复发性肩关节MDI患者。
