Bolia Ioanna K, Griffith Rebecca, Fretes Nickolas, Petrigliano Frank A
USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA.
Video J Sports Med. 2021 Jun 8;1(3):26350254211007142. doi: 10.1177/26350254211007142. eCollection 2021 May-Jun.
The management of multidirectional instability (MDI) of the shoulder remains challenging, especially in athletes who participate in sports and may require multiple surgical procedures to achieve shoulder stabilization. Open or arthroscopic procedures can be performed to address shoulder MDI.
Open capsulorrhaphy is preferred in patients with underlying tissue hyperlaxity and who had 1 or more, previously failed, arthroscopic shoulder stabilization procedures.
With the patient in the beach-chair position (45°), tissue dissection is performed to the level of subscapularis tendon via the deltopectoral approach. The subscapularis tenotomy is performed in an L-shaped fashion, and the subscapularis tendon is tagged with multiple sutures and mobilized. Careful separation of the subscapularis tendon from the underlying capsular tissue is critical. Capsulotomy is performed, consisting of a vertical limb and an inferior limb that extends to the 5 o'clock position on the humeral neck (right shoulder). After evaluating the integrity of the labrum, the capsule is shifted superiorly and laterally, and repaired using 4 to 5 suture anchors. The redundant capsule is excised, and the subscapularis tendon is repaired in a side-to-side fashion, augmented by transosseous equivalent repair using the capsular sutures.
Adequate shoulder stabilization was achieved following open capsulorrhaphy in a young female athlete with tissue hyperlaxity and history of a previously failed arthroscopic soft tissue stabilization surgery of the shoulder. The athlete returned to sport at 6 months postoperatively and did not experience recurrent shoulder instability episodes at midterm follow-up.
DISCUSSION/CONCLUSION: Based on the existing literature, 82% to 97% of patients who underwent open capsulorrhaphy for MDI had no recurrent shoulder instability episodes at midterm follow-up. One study reported 64% return-to-sport rate following open capsulorrhaphy in 15 adolescent athletes with Ehlers-Danlos syndrome, but more research is necessary to better define the indications and outcomes of this procedure in physically active patients.
肩部多向不稳定（MDI）的治疗仍然具有挑战性，尤其是对于参与运动的运动员，可能需要多次手术才能实现肩部稳定。可以采用开放手术或关节镜手术来处理肩部MDI。
对于存在潜在组织过度松弛且曾有1次或更多次关节镜下肩部稳定手术失败的患者，首选开放关节囊缝合术。
患者取沙滩椅位（45°），经三角肌胸大肌入路进行组织分离至肩胛下肌腱水平。肩胛下肌肌腱切断术采用L形方式进行，并用多根缝线标记肩胛下肌肌腱并使其活动。将肩胛下肌肌腱与下方的关节囊组织仔细分离至关重要。进行关节囊切开术，包括一个垂直切口和一个延伸至肱骨颈5点钟位置（右肩）的下切口。评估盂唇完整性后，将关节囊向上和向外移位，并用4至5个缝合锚钉进行修复。切除多余的关节囊，肩胛下肌肌腱以侧对侧方式修复，并通过使用关节囊缝线进行经骨等效修复来加强。
一名年轻女性运动员存在组织过度松弛且曾有肩部关节镜下软组织稳定手术失败史，接受开放关节囊缝合术后实现了充分的肩部稳定。该运动员术后6个月恢复运动，中期随访时未出现复发性肩部不稳定发作。
讨论/结论：根据现有文献，接受开放关节囊缝合术治疗MDI的患者中，82%至97%在中期随访时未出现复发性肩部不稳定发作。一项研究报告了15名患有埃勒斯-当洛综合征的青少年运动员接受开放关节囊缝合术后64%的恢复运动率，但需要更多研究来更好地确定该手术在身体活跃患者中的适应症和结果。
