Capuzzo Marco, Mizuno Fernando Henrique, Maci Gaetano, Carboni Luca, Emmi Aron, Macchi Veronica, De Caro Raffaele, Porzionato Andrea, Boscolo-Berto Rafael
Orthopedic Unit, Villa Regina Hospital, Bologna, Italy.
M2Clinic, Treviso, Italy.
Front Surg. 2025 Jun 2;12:1578404. doi: 10.3389/fsurg.2025.1578404. eCollection 2025.
Multidirectional instability (MDI) of the shoulder joint involves the looseness of the joint capsule in multiple directions, resulting in difficulties in keeping the head of the humerus centered within the glenoid fossa. There is still considerable debate about the optimal treatment approach, ranging from conservative management to surgical intervention and it is even more challenging for complex or bilateral cases. An 18-year-old male with a rare congenital bilateral multidirectional glenohumeral hyperlaxity and instability is reported. After excluding other medical conditions, the patient was diagnosed with benign joint hypermobility syndrome. Despite undergoing four months of conservative treatment with physical therapy, there was no significant improvement, leading to the decision for bilateral surgical intervention. The procedure combined an autograft Posterior Bone Block procedure with the Arthroscopic Subscapularis Augmentation (ASA) Technique to enhance anterior stability. The latter involved a tenodesis of the superior third part of the subscapularis tendon. The fixating hole was drilled at the top position of the glenoid edge, and the insertion on the subscapularis tendon was positioned inferiorly to the superior border of the tendon. After surgery, an accelerated post-operative rehabilitation protocol for each shoulder was implemented. At the one-year follow-up after the second surgery, the patient demonstrated substantial improvements in shoulder stability and functional outcomes. The Constant Shoulder Score (CSS) improved from 53 to 77 for both shoulders, indicating a 45.3% improvement and progression from "Moderate" to "Good" function. Similarly, the American Shoulder and Elbow Surgeons (ASES) Orthopaedic Scores improved from 58.33 to 88.32 for the right shoulder (51.4% improvement) and from 61.65 to 94.99 for the left shoulder (54.1% improvement), reflecting a transition from "Fair" to "Good" and "Excellent" function, respectively. Importantly, no short- or medium-term adverse events were reported, and the patient achieved a full return to normal activities. The combination of autograft Posterior Bone Block and ASA techniques has proven to be a successful option in this case for restoring function and stability, even in rare and complex cases of congenital bilateral multidirectional glenohumeral hyperlaxity and instability. Nonetheless, in these complex cases, critical surgical, anatomical, and forensic issues should be carefully considered.
肩关节多向不稳定（MDI）涉及关节囊在多个方向上的松弛，导致肱骨头难以保持在关节盂窝中心。关于最佳治疗方法仍存在相当大的争议，从保守治疗到手术干预，对于复杂或双侧病例而言更具挑战性。本文报道了一名18岁男性，患有罕见的先天性双侧多向性盂肱关节过度松弛和不稳定。排除其他疾病后，该患者被诊断为良性关节过度活动综合征。尽管接受了四个月的物理治疗保守治疗，但并无显著改善，因此决定进行双侧手术干预。该手术将自体骨移植后骨块手术与关节镜下肩胛下肌增强（ASA）技术相结合，以增强前稳定性。后者涉及肩胛下肌腱上三分之一的腱固定术。在关节盂边缘的顶部位置钻孔作为固定孔，肩胛下肌腱上的插入位置位于肌腱上缘下方。手术后，为每个肩部实施了加速术后康复方案。在第二次手术后的一年随访中，患者的肩部稳定性和功能结果有了显著改善。双肩的Constant肩关节评分（CSS）从53提高到77，改善了45.3%，功能从“中度”进展到“良好”。同样，美国肩肘外科医生（ASES）骨科评分，右肩从58.33提高到88.32（改善51.4%），左肩从61.65提高到94.99（改善54.1%），分别反映了从“一般”到“良好”和“优秀”功能的转变。重要的是，未报告短期或中期不良事件，患者已完全恢复正常活动。自体骨移植后骨块和ASA技术的结合已被证明在这种情况下是恢复功能和稳定性的成功选择，即使在先天性双侧多向性盂肱关节过度松弛和不稳定的罕见复杂病例中也是如此。尽管如此，在这些复杂病例中，关键的手术、解剖和法医问题仍应仔细考虑。
