Double-Allograft Shoulder Stabilization for Multidirectional Instability Is Associated With Improved Function and Survivability After 2 Years

Abstract

Purpose

To describe a double-allograft technique used for patients with severe, symptomatic multidirectional instability and hyperlaxity of the shoulder as well as to introduce a modification of the Beighton score that helps determine when this procedure should be utilized and report long-term outcomes of this procedure in the management of these patients.

Methods

A retrospective review of patients with multidirectional instability who were managed with the double-allograft technique after failure of extensive physical therapy was conducted. The final analysis included 43 patients (46 shoulders). Included patients had minimum 2 years of in-office follow-up with a Tulane modified Beighton score of 11 or greater and severe multidirectional instability/hyperlaxity of the shoulder. Preoperative and postoperative patient-reported outcome (PRO) measures were compared using 2-tailed paired t -tests. Subgroup analyses were performed using 2-tailed, independent t-tests.

Results

Mean postoperative outcome scores were significantly improved compared with preoperative scores for all PRO measures evaluated from the 6-month postoperative visit on (all P < .001). Subgroup analyses of gender, age, and patients with versus without genetically confirmed Ehlers-Danlos syndrome were equivalent with respect to postoperative improvements in PRO scores. The average Tulane modified Beighton score was 14, range 11 to 15. Among the 46 operative cases, there were a total of 7 (15.2%) complications and 5 recurrences requiring additional surgery. The 5 (10.9%) patients who underwent a subsequent revision procedure did so at a mean time of 5.36 ± 2.64 years.

Conclusions

The double allograft reconstruction technique appears to be a safe and effective method to restore shoulder stability in patients with severe ligamentous laxity.

Level of Evidence

Level IV, therapeutic case series.