JSES - 2026-06-02 - Journal Article
Open Capsular Shift with Achilles Allograft Augmentation for Multidirectional Shoulder Instability: Long-Term Outcomes and Implications for Patients with Ehlers-Danlos Syndrome.
Albarian SB, Trinh PMP, Simonian L, Nathan K, Eliasberg CD, Rodeo SA
Topics
Key Takeaway
Open capsular shift with Achilles allograft augmentation achieved 0% recurrent instability rate at mean 10-year follow-up in 10 shoulders with MDI, including EDS patients, with mean ASES of 73 and SSV of 79.5%.
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Summary
This study evaluated long-term PROMs and recurrence rates after open capsular shift with Achilles tendon allograft augmentation in MDI patients, including those with hypermobile-type EDS, who failed conservative management. Nine patients (10 shoulders) were assessed by telephone survey at mean 10-year follow-up. No recurrent subluxations or dislocations occurred; mean ASES was 73, mean WOSI 30%, mean SSV 79.5%, and 2 shoulders required subsequent shoulder arthroplasty at 8 and 14 years postoperatively.
Key Limitation
The sample size of 10 shoulders is insufficient to draw statistically meaningful conclusions or identify predictors of the two arthroplasty conversions, severely limiting generalizability.
Original Abstract
BACKGROUND
Multidirectional shoulder instability (MDI) remains a challenging clinical problem, particularly in patients with connective tissue disorders such as Ehlers-Danlos Syndrome (EDS). While MDI may often be successfully treated non-operatively, surgical intervention is indicated when conservative management fails. While open or arthroscopic capsular shift is often utilized, allograft tissue augmentation may be required for patients with recurrent instability and deficient capsular tissue. The purpose of this study was to evaluate long-term patient reported outcomes following open capsular shift with Achilles allograft capsular augmentation in patients with MDI. We hypothesized that Achilles allograft augmentation would lead to improved clinical outcomes and low rates of recurrent instability in this high-risk population.
METHODS
Study approval was obtained by our Institutional Review Board. Patients who underwent open capsular shift with Achilles tendon allograft augmentation for MDI by the senior author were identified retrospectively. Inclusion criteria consisted of MDI due to hypermobile type EDS or MDI without a diagnosed underlying connective tissue disorder. Patients with instability resulting from traumatic injuries were excluded. Outcomes were determined by telephone survey with no physical examination or radiographic follow-up. Five standard patient-reported outcome measures (PROMs) were collected: American Shoulder and Elbow Surgeons (ASES), Western Ontario Shoulder Instability Index (WOSI), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), and Subjective Shoulder Value (SSV). Recurrent instability, patient satisfaction, pain, and subsequent surgical intervention were also assessed.
RESULTS
Nine patients (10 shoulders) with a mean age of 32 years (range, 22 to 55) and mean follow-up of 10 years (range, 2.0-20.3) were included. No patients experienced recurrent subluxations or dislocations post-operatively. The mean subjective pain rating was 1.9 (range, 0-5). Eight of 9 patients returned to sports, work, and activities of daily living. Mean ASES score was 73 (range, 43-100), mean WOSI score was 30% (range 0.5-61.9%), mean SSV score was 79.5% (range, 50-100%), mean PCS score was 2.7 (range, 0-11), and mean TSK score was 32 (range, 20-41). Two shoulders underwent subsequent shoulder replacement surgery at 8 and 14 years post-operatively.
CONCLUSION
Open capsular shift with Achilles tendon allograft augmentation can be an effective procedure for restoring long-term shoulder stability and functionality in patients with MDI, including those with connective tissue disorders such as EDS.