Open Modified Gallie Procedure for Chronic Anterior Shoulder Instability.

Abstract

A 65-year-old female patient with capsular insufficiency was treated with open modified Gallie anatomic reconstruction using a tibialis anterior allograft and inferior capsular shift. The patient was previously diagnosed with adhesive capsulitis but suffered from multiple dislocations and persistent pain with both subjective and physical examination findings of instability after manipulation. Diagnosis of capsular insufficiency secondary to humeral avulsion of the glenohumeral ligaments was made with magnetic resonance imaging with arthrography demonstrating contrast extravasation from the axillary pouch. After confirmatory diagnostic arthroscopy, the deltopectoral approach with subscapularis sparing technique subsequently was used to reconstruct the anterior capsule. A tibialis anterior graft was inserted into bone tunnels in the glenoid and anchored to the humerus. Anchors were inserted into the glenoid for inferior capsule shift of the torn inferior glenohumeral ligament. The patient experienced immediate resolution of instability and relief of pain on follow-up. Functional outcomes at 12 months were satisfactory with only a mild reduction in function with overhead activities and internal rotation. It is proposed that open reconstruction of the anterior capsule with inferior capsular shift is the procedure of choice for patients with recurrent anterior shoulder dislocations because of capsular insufficiency with humeral avulsion of the glenohumeral ligaments lesions.