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• W3216486640 abstract "The patient was a 46-year-old right hand–dominant healthy male who presented with complaints of left shoulder pain and instability. He had been experiencing these symptoms since he was 20 years old, with his onset of symptoms whether traumatic or atraumatic being unclear. In his early 20s, he underwent three arthroscopic interventions to his left shoulder which included at least one arthroscopic capsular shift. Additionally, at the age of 26 years, he underwent an arthroscopic capsulorrhaphy for anterior instability followed by an open distal clavicle excision presumably to address his diffuse anterior shoulder pain. The patient continued to have recurrent pain and anterior instability and underwent left rotator cuff repair and pectoralis major tendon transfer for subscapularis deficiency at the age of 31 years. Although we did not have a clear traumatic history from the patient concerning a rotator cuff tear, his subscapularis tear and deficiency clearly played a large role in his recalcitrant instability as did his lack of a normal anterior capsule/ inferior glenohumeral ligament. The patient then had another arthroscopic debridement and capsulorrhaphy at the age of 34 years for instability. The patient continued to have significant pain and instability to the degree that he could not remove his shirt using the left arm. He endorsed an almost daily dislocation rate and persistent subluxation events. These symptoms were refractory to both dedicated physical therapy and corticosteroid injections. He was able to work as a forklift driver but required regular mild narcotic use for pain control. His left shoulder preoperative range of motion was forward flexion to 140 degrees with pain and external rotation to 70 with pain and apprehension. His preoperative outcome scores were Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score of 47.7, Simple Shoulder Test of 5, American Shoulder and Elbow Surgeons (ASES) score of 48, and Shoulder Single Assessment Numeric Evaluation (SANE) of 50%. Current magnetic resonance imaging showed a chronic subscapularis tear with G4 muscle atrophy, pec major transfer with scarring, an intact long head of the biceps tendon with mild medial subluxation at the top of the groove, and intact supraspinatus, infraspinatus, and teres minor tendons. His glenohumeral joint space was maintained on radiographs, and his magnetic resonance imaging showed some mild glenohumeral chondromalacia. Although the patient was initially referred for evaluation for shoulder arthroplasty, a thorough discussion was held regarding his options including continued nonoperative care, shoulder arthroplasty, and shoulder arthroscopy (labral repair versus debridement, possible open capsular reconstruction with dermal allograft versus capsular tightening, and biceps tenodesis). Given the patient’s young age, the patient decided to pursue a capsular reconstruction procedure in an effort to delay arthroplasty. At surgery, examination under anesthesia showed +2 anterior drawer test, +1 posterior drawer, and external rotation of 85 degrees with the arm at the side. Diagnostic arthroscopy showed a type 3 SLAP tear, absent subscapularis tendon with scarring in the anterior glenohumeral joint (Fig. 1), grade 4 chondromalacia on the anterior glenoid (with the remainder having grade 2-3 chondromalacia) with a blunted but present anteroinferior labrum with evidence of prior capsulorrhaphy (Fig. 2), and intact supraspinatus/infraspinatus/teres minor tendons. Debridement and biceps tenotomy were performed arthroscopically as well as removal of one anteroinferior labral suture. Attention was then turned to the open capsular reconstruction. The deltopectoral approach was used with significant scarring secondary to the pectoralis tendon transfer. Some anterior capsular tissue appeared to be present but was very thin. The biceps tendon was tenodesed to the soft tissue in the inferior aspect of the bicipital groove. The thin remaining anterior capsular tissue was incised longitudinally, and deficiencies of the superior capsule as well as the anteroinferior glenohumeral ligament were noted. There was fatty degenerative tissue over the lesser tuberosity which was excised. Anterior glenoid was exposed, and two double-loaded Arthrex FiberTak anchors (Arthrex, Naples, FL, USA) were inserted. One limb of each tail was passed superficial to deep and deep to superficial through the remaining labrum. Then, two biocomposite anchors were placed on the medial aspect of the lesser tuberosity (Fig. 3). A 4-mm acellular dermal allograft (ArthroFlex; Lifenet Health, Virginia Beach, VA, USA) was sized appropriately and cut on the back table. The free sutures from the glenoid anchors were passed through the graft in a double pulley technique for 1 set of sutures and a horizontal mattress for the sutures that had passed through the labrum slightly more laterally on the medial aspect of the graft. The double pulley sutures were tied first followed by the horizontal mattress sutures. The lateral aspect of the graft was then draped across the anterior glenohumeral joint, and extraneous graft laterally was cut with the arm in a position of 45 degrees of abduction and 30 degrees of external rotation. The lateral anchors were passed in a horizontal mattress fashion through the graft and tied. The sutures were then passed over the lateral soft tissue forming a lateral double row without anchors. One suture limb from the horizontal mattress sutures on each side of the joint was tied together for an internal brace effect. The superior aspect of the allograft was then sutured to the remaining supraspinatus tendon using a combination of absorbable and nonabsorbable sutures. Schematic of the anterior capsular reconstruction construct is presented in (Fig. 4). Layered closure was performed with absorbable suture.Figure 2Arthroscopic image of the anteroinferior glenoid with one prior visible suture anchor and a blunted anterior labrum.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Image of the anterior glenohumeral joint with absent subscapularis. Medial anchors () are noted on the glenoid, and lateral anchors () are placed on the medial aspect of the lesser tuberosity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4Schematic drawing of the anterior capsular reconstruction construct used in this case.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The patient remained in a sling for 6 weeks and was non–weight-bearing for 4 months. At 6 weeks postoperatively, the patient began physical therapy with limitations to 30 degrees of external rotation for another 6 weeks and passive, active assist, and active forward elevation to tolerance. Internal rotation past the abdomen was allowed after 6 weeks. The patient did well postoperatively with significant improvement in his pain and function as shown by improved outcome scores and less pain (Table I). At his 30-month follow-up, the patient had no complaints of instability events and had returned to his job as a fork lift driver without limitation. His final SANE score was 70%, with a 4-point improvement in his Simple Shoulder Test at the final follow-up. The patient was informed and consented to the submission of his clinical data for publication in the form of a case report.Table IPatient’s shoulder range of motion and outcome scores at different time points.Time pointActive forward flexionActive external rotationActive internal rotationQuickDASHSSTASES scoreShoulder SANEVAS painPreop140° (170° contra)70° (45° contra)L2 (T11 contra)47.754850%76 months postop160°40° (80° @ 90° abduction)L16.8118280-90%218 months postop---18.2117875-80%430 months postop---36.496270%5ASES, American Shoulder and Elbow Surgeons; SANE, Single Assessment Numeric Evaluation; SST, Simple Shoulder Test; VAS, visual analog scale. Open table in a new tab ASES, American Shoulder and Elbow Surgeons; SANE, Single Assessment Numeric Evaluation; SST, Simple Shoulder Test; VAS, visual analog scale. Chronic anterior shoulder instability affects many patients, particularly individuals involved in collision sports. Traumatic shoulder dislocation or subluxation, defined as soft-tissue or bony insult that causes the humeral head to subluxate or dislocate from the glenoid fossa, accounts for 95% of shoulder instability events.5Cofield R.H. Kavanagh B.F. Frassica F.J. Anterior shoulder instability.Instr Course Lect. 1985; 34: 210-227PubMed Google Scholar,27Varacallo M. Musto M.A. Mair S.D. Anterior shoulder instability. StatPearls Publishing, Treasure Island, FL2021Google Scholar,28Walton J. Paxinos A. Tzannes A. Callanan M. Hayes K. Murrell G.A. The unstable shoulder in the adolescent athlete.Am J Sports Med. 2002; 30: 758-767https://doi.org/10.1177/03635465020300052401Crossref PubMed Scopus (79) Google Scholar Even after recovery from a primary shoulder dislocation, athletes who return to sports are prone to recurrent injury and instability. Conservative treatment approaches, such as physical therapy, provide a noninvasive option that typically leads to clinical improvement in patients with atraumatic instability, however, young patients with instability stemming from traumatic events who continue to play contact sports typically progress to requiring surgical interventions.3Burgess B. Sennett B. Traumatic shoulder instability.Orthop Nurs. 2003; 22: 345-350https://doi.org/10.1097/00006416-200309000-00011Crossref PubMed Scopus (5) Google Scholar Open and arthroscopic stabilization procedures have been met with high success, preventing recurrent instability events in most patients (79%-100%).3Burgess B. Sennett B. Traumatic shoulder instability.Orthop Nurs. 2003; 22: 345-350https://doi.org/10.1097/00006416-200309000-00011Crossref PubMed Scopus (5) Google Scholar,8Friedman L. Griesser M. Miniaci A. Jones M. Recurrent instability after revision anterior shoulder stabilization surgery.Arthroscopy. 2014; 30: 372-381https://doi.org/10.1016/j.arthro.2013.11.019Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar,11Hale J. Rokito A.S. Chu J. Anterior capsulolabral reconstruction for traumatic recurrent anterior shoulder dislocation.Bull Hosp Joint Dis. 2005; 62: 94-98PubMed Google Scholar,26Thal R. Nofziger M. Bridges M. Kim J.J. Arthroscopic Bankart repair using Knotless or BioKnotless suture anchors: 2- to 7-year results.Arthroscopy. 2007; 23: 367-375https://doi.org/10.1016/j.arthro.2006.11.024Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar,31Zaffagnini S. Marcheggiani Muccioli G.M. Giordano G. Bonanzinga T. Grassi A. Nitri M. et al.Long-term outcomes after repair of recurrent post-traumatic anterior shoulder instability: comparison of arthroscopic transglenoid suture and open Bankart reconstruction.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 816-821https://doi.org/10.1007/s00167-011-1674-yCrossref PubMed Scopus (49) Google Scholar For the patients with recurrent instability despite surgical intervention, additional procedures prove challenging owing to deficiencies of the anterior capsule and ligamentous complex as well as anterior glenoid bony loss. Subscapularis insufficiency is a less common problem leading to anterior shoulder instability but is associated with devastating functional deficits, often requiring salvage surgical approaches.17Millett P.J. Clavert P. Warner J.J.P. Open operative treatment for anterior shoulder instability.J Bone Joint Surg. 2005; 87: 419-432https://doi.org/10.2106/JBJS.D.01921Crossref PubMed Scopus (119) Google Scholar,20Pastor M.F. Kraemer M. Wellmann M. Hurschler C.,T. Smith anterior stability of the reverse shoulder arthroplasty depending on implant configuration and rotator cuff condition.Arch Orthop Trauma Surg. 2016; 136: 1513-1519https://doi.org/10.1007/s00402-016-2560-3Crossref PubMed Scopus (22) Google Scholar,22Rodeo S.A. Suzuki K. Yamauchi M. Bhargava M. Warren R.F. Analysis of collagen and elastic fibers in shoulder capsule in patients with shoulder instability.Am J Sports Med. 1998; 26: 634-643Crossref PubMed Scopus (72) Google Scholar Such approaches include tendon transfers, such as pectoralis major and latissimus dorsi transfers.4Clark N. Elhassan B. The role of tendon transfers for irreparable rotator cuff tears.Curr Rev Musculoskelet Med. 2018; 11: 141-149https://doi.org/10.1007/s12178-018-9468-1Crossref PubMed Scopus (19) Google Scholar,19Nelson G.N. Namdari S. Galatz L. Keener J.D. Pectoralis major tendon transfer for irreparable subscapularis tears.J Shoulder Elbow Surg. 2014; 23: 909-918https://doi.org/10.1016/j.jse.2013.12.035Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar These tendon transfers are associated with functional improvements but fundamentally alter joint kinematics and are reliant on a competent posterior rotator cuff. Elhassan et al found high complication rates when performing pectoralis major tendon transfer on patients with diminished subscapularis integrity, with clinical failure rates of 27% and 36% from groups of patients that had previously failed procedures for shoulder instability or had massive tears of the rotator cuff.7Elhassan B. Ozbaydar M. Massimini D. Diller D. Higgins L. Warner J. Transfer of pectoralis major for the treatment of irreparable tears of subscapularis.J Bone Joint Surg Br. 2008; 90-B: 1059-1065https://doi.org/10.1302/0301-620X.90B8.20659Crossref Scopus (102) Google Scholar Latissimus dorsi tendon transfers offer another option for irreparable subscapularis tears but have been met with high clinical failure (41%) and complication rates such as potential axillary nerve injury.18Muench L.N. Kia C. Williams A.A. Avery D.M. Cote M.P. Reed N. et al.High clinical failure rate after Latissimus Dorsi transfer for revision massive rotator cuff tears.Arthroscopy. 2020; 36: 88-94https://doi.org/10.1016/j.arthro.2019.07.034Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar The Bristow and Latarjet techniques offer additional options for addressing recurrent anterior shoulder instability, but these approaches have their complications and the risk of reoperation persists.10Griesser M. Harris J. McCoy B. Hussain W. Jones M. Bishop J. et al.Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review.J Shoulder Elbow Surg. 2013; 22: 286-292https://doi.org/10.1016/j.jse.2012.09.009Abstract Full Text Full Text PDF PubMed Scopus (315) Google Scholar A large meta-analysis of the Latarjet procedure versus a Bankart repair performed by Imam et al including >3000 patients found that the Latarjet procedure was more effective than Bankart procedures at preventing recurrent instability at 6-10 years postoperatively without increased complications.13Imam M. Shehata M. Martin A. Attia H. Sinokrot M. Bahbah E. et al.Bankart repair versus Latarjet procedure for recurrent anterior shoulder instability: a systematic review and meta-analysis of 3275 shoulders.Am J Sports Med. 2020; 49: 1945-1953https://doi.org/10.1177/0363546520962082Crossref PubMed Scopus (4) Google Scholar These findings echoed an earlier meta-analysis performed by An et al with >700 patients which also showed that the Latarjet procedure offered greater stability than the Bankart repair with no significant increase in complications.2An V. Sivakumar B. Phan K. Trantalis J. A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair.J Shoulder Elbow Surg. 2016; 25: 853-863https://doi.org/10.1016/j.jse.2015.11.001Abstract Full Text Full Text PDF PubMed Scopus (121) Google Scholar Improvements in complication rates compared with the Bankart repair does not necessarily mean that the complication rate is low. A different comprehensive review of the literature, conducted by Griesser et al, found a total complication rate of 30% when investigating 45 studies (1904 shoulders), with recurrent dislocation rates being 2.9% among open surgeries and 5.8% among those performed arthroscopically.10Griesser M. Harris J. McCoy B. Hussain W. Jones M. Bishop J. et al.Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review.J Shoulder Elbow Surg. 2013; 22: 286-292https://doi.org/10.1016/j.jse.2012.09.009Abstract Full Text Full Text PDF PubMed Scopus (315) Google Scholar In total, nearly 7% of patients required unplanned reoperation after surgery.10Griesser M. Harris J. McCoy B. Hussain W. Jones M. Bishop J. et al.Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review.J Shoulder Elbow Surg. 2013; 22: 286-292https://doi.org/10.1016/j.jse.2012.09.009Abstract Full Text Full Text PDF PubMed Scopus (315) Google Scholar Domos et al found moderately high rates of postoperative complications (15%), which include infection, frozen shoulder, hematoma formation, symptomatic implants, fracture or nonunion of the coracoid graft, neurological complications, arthritis, and recurrence of instability.6Domos P. Lunini E. Walch G. Contraindications and complications of the Latarjet procedure.Shoulder Elbow. 2017; 10: 15-24https://doi.org/10.1177/1758573217728716Crossref PubMed Scopus (51) Google Scholar These results were mirrored by a systematic review completed by Longo et al including >1000 patients revealing a complication rate of 15% including postoperative infections, neurologic injuries, and stiffness, among others.15Longo U. Loppini M. Rizzello G. Ciuffreda M. Maffulli N. Denaro V. Latarjet, Bristow, and Eden-Hybinette procedures for anterior shoulder dislocation: systematic review and quantitative synthesis of the literature.Arthroscopy. 2014; 30: 1184-1211https://doi.org/10.1016/j.arthro.2014.04.005Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar An analysis performed by Willemot et al in the setting of revision Bristow/Latarjet procedures revealed that the primary causes of failures were graft nonunion (42.3%) and graft resorption (23.1%).30Willemot L. De Boey S. Van Tongel A. Declercq G. De Wilde L. Verborgt O. Analysis of failures after the Bristow-Latarjet procedure for recurrent shoulder instability.Int Orthop. 2019; 43: 1899-1907https://doi.org/10.1007/s00264-018-4105-6Crossref PubMed Scopus (23) Google Scholar Although the Bristow and Latarjet surgical techniques offer an effective approach to ameliorating anterior shoulder instability with bony deficiency, these complications remain problematic. In addition to these complications, concerns about long-term development of shoulder arthritis exist with these procedures.12Hovelius L. Sandström B. Rösmark D. Saebö M. Sundgren K. Malmqvist B. Long-term results with the Bankart and Bristow-Latarjet procedures: recurrent shoulder instability and arthropathy.J Shoulder Elbow Surg. 2001; 10: 445-452Abstract Full Text Full Text PDF PubMed Scopus (213) Google Scholar,23Samilson R.L. Prieto V. Dislocation arthropathy of the shoulder.J Bone Joint Surg Am. 1983; 65: 456-460Crossref PubMed Scopus (610) Google Scholar,25Singer G.C. Kirkland P.M. Emery R.J. Coracoid transposition for recurrent anterior instability of the shoulder. A 20-year follow-up study.J Bone Joint Surg Br. 1995; 77-B: 73-76Crossref Google Scholar Several different techniques for anterior capsule reconstruction are present in the literature but have been met with mixed clinical outcomes. Alcid et al performed a case series using hamstring tendon allografts (n = 9) or tibialis tendon allograft (n = 6) to reinforce deficient anterior capsular tissue in shoulder instability patients who had previously failed shoulder immobilization.1Alcid J. Powell S. Tibone J. Revision anterior capsular shoulder stabilization using hamstring tendon autograft and tibialis tendon allograft reinforcement: minimum two-year follow-up.J Shoulder Elbow Surg. 2007; 16: 268-272https://doi.org/10.1016/j.jse.2006.07.008Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar In follow-up, 5 patients (3/9 hamstring autograft patients and 2/6 of tibialis anterior autograft) continued to experience subluxation events and postoperative restricted range of motion with regards to forward flexion (10◦), external rotation at the side (21◦), external rotation with the arm in abduction (24◦), and 4 spinal levels of internal rotation.1Alcid J. Powell S. Tibone J. Revision anterior capsular shoulder stabilization using hamstring tendon autograft and tibialis tendon allograft reinforcement: minimum two-year follow-up.J Shoulder Elbow Surg. 2007; 16: 268-272https://doi.org/10.1016/j.jse.2006.07.008Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar Anterior capsular reconstruction with Achilles tendon allograft offers another approach to this clinical challenge, particularly for patients with Ehlers-Danlos syndrome; however, long-term outcome data remain limited, with failure rates reported ranging from 20% to 69%.16MacDonald P. McRae S. Leiter J. Mascarenhas R. Achilles allograft stabilization of the shoulder in refractory multidirectional glenohumeral instability.Tech Shoulder Elbow Surg. 2008; 9: 60-65https://doi.org/10.1097/BTE.0b013e31816938daCrossref Scopus (3) Google Scholar,24Schoorl T.J. Nguyen N.T.V. van Noort A. Alta T.D.W. Sanchez-Sotelo J. Capsulorraphy with Achilles allograft augmentation for shoulder instability in patients with Ehlers-Danlos syndrome.J Shoulder Elbow Surg. 2021; 30: 865-870https://doi.org/10.1016/j.jse.2020.07.019Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Reconstruction of the anterior capsule using a dermal allograft has previously been described in the literature, but postoperative data remain limited and additional clinical trials are required to determine the long-term clinical implications.9Gallagher F. Wong I. Anterior capsule augmentation and posterior glenohumeral capsular reconstruction with human dermal allograft for multidirectional shoulder instability.Arthrosc Tech. 2020; 9: e657-e662https://doi.org/10.1016/j.eats.2020.01.020Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar,14Kwapisz A. Tokish J. Anterior capsule reconstruction technique with an acellular dermal allograft.Arthrosc Tech. 2017; 6: e1945-e1952https://doi.org/10.1016/j.eats.2017.07.012Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,21Pogorzelski J. Hussain Z.B. Lebus G.F. Fritz E.M. Millett P.J. Anterior capsular reconstruction for irreparable subscapularis tears.Arthrosc Tech. 2017; 6: e951-e958https://doi.org/10.1016/j.eats.2017.03.008Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar,29Whelan A. Coady C. Ho-Bun Wong I. Anterior glenohumeral capsular reconstruction using a human acellular dermal allograft.Arthrosc Tech. 2018; 7: e1235-e1241https://doi.org/10.1016/j.eats.2018.08.002Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Promising elements of this approach include reduced surgical pain, decreased harvest site morbidity, and increased postoperative range of motion.29Whelan A. Coady C. Ho-Bun Wong I. Anterior glenohumeral capsular reconstruction using a human acellular dermal allograft.Arthrosc Tech. 2018; 7: e1235-e1241https://doi.org/10.1016/j.eats.2018.08.002Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Anterior capsular reconstruction appears to be a viable option for recurrent shoulder instability with deficient anterior soft-tissue stabilizers. To our knowledge, there is only one study in the literature that reports follow-up data on one patient receiving anterior capsular reconstruction with a dermal allograft.32Zink T. Triplet J.J. Myers D.M. Taylor B.C. Wiseman S.P. Long N.K. Anterior capsular reconstruction of the shoulder for chronic instability using a dermal allograft.Tech Shoulder Elbow Surg. 2019; 20: 92-95https://doi.org/10.1097/BTE.0000000000000172Crossref Scopus (0) Google Scholar A case report on a 42-year-old male, who had previously failed arthroscopic Bankart repair and an open Latarjet procedure to his nondominant arm, was described by Zink et al.32Zink T. Triplet J.J. Myers D.M. Taylor B.C. Wiseman S.P. Long N.K. Anterior capsular reconstruction of the shoulder for chronic instability using a dermal allograft.Tech Shoulder Elbow Surg. 2019; 20: 92-95https://doi.org/10.1097/BTE.0000000000000172Crossref Scopus (0) Google Scholar At a 24-month postoperative follow-up, the patient’s shoulder remained stable, with no recurrent instances of anterior subluxation or dislocation.32Zink T. Triplet J.J. Myers D.M. Taylor B.C. Wiseman S.P. Long N.K. Anterior capsular reconstruction of the shoulder for chronic instability using a dermal allograft.Tech Shoulder Elbow Surg. 2019; 20: 92-95https://doi.org/10.1097/BTE.0000000000000172Crossref Scopus (0) Google Scholar Functional outcome scores for the ASES, Constant, and SANE were measured to be 70%, 97%, and 50%, respectively. The visual analog scale pain score was rated at 0 with only minor anterior shoulder discomfort during activity reported by the patient at the final follow-up.32Zink T. Triplet J.J. Myers D.M. Taylor B.C. Wiseman S.P. Long N.K. Anterior capsular reconstruction of the shoulder for chronic instability using a dermal allograft.Tech Shoulder Elbow Surg. 2019; 20: 92-95https://doi.org/10.1097/BTE.0000000000000172Crossref Scopus (0) Google Scholar Although the patient described in this report had many clinical similarities to that of Zink et al, it should be noted that the patient from this study had undergone a Mumford procedure and pectoralis major tendon transfer instead of prior bony instability procedures.32Zink T. Triplet J.J. Myers D.M. Taylor B.C. Wiseman S.P. Long N.K. Anterior capsular reconstruction of the shoulder for chronic instability using a dermal allograft.Tech Shoulder Elbow Surg. 2019; 20: 92-95https://doi.org/10.1097/BTE.0000000000000172Crossref Scopus (0) Google Scholar The findings described in this case report corroborate the positive experience of anterior capsular reconstruction described by Zink et al. Our patient described experienced improvements in the QuickDASH score, Simple Shoulder Test, ASES score, and Shoulder SANE. These improvements occurred despite his significant surgical history including multiple capsulorrhaphies and a failed pectoralis major tendon transfer. This case demonstrates that anterior capsular reconstruction with acellular dermal allograft may be a viable option when treating patients with refractory anterior instability and a deficient anterior capsule. Further clinical investigations, particularly long-term follow-up data and case series, are still required to elucidate the potential of this surgical option for patients with recalcitrant anterior shoulder instability." @default.
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• W3216486640 title "Anterior Capsular Reconstruction for Recurrent Anterior Shoulder Instability: A Case Report using Dermal Allograft" @default.
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