Anterior Capsule Augmentation and Posterior Glenohumeral Capsular Reconstruction With Human Dermal Allograft for Multidirectional Shoulder Instability

Recurrent multidirectional shoulder instability is a common clinical presentation in certain demographics and sporting groups. One such demographic is patients with connective tissue disorders (CTD) such as Ehlers-Danlos syndrome (EDS), in whom shoulder pathologies are exacerbated owing to ligamentous laxity. Features of this laxity can present as both anterior and posterior shoulder instability, which are problematic sources of shoulder pain. Many patients with these injuries require surgical anterior and/or posterior glenohumeral reconstruction. Surgical reconstruction for posterior capsular defects can be challenging and has higher failure rates compared with anterior capsular reconstruction methods. Management can be especially difficult for patients with CTDs, and there is a requirement for the development of novel surgical techniques. Human acellular dermal allografts have been found to be particularly useful for patients with CTDs compared with other methods that use the patient's own tissue for the repair. This note and surgical video describe an all-arthroscopic technique for a combined anterior capsule augmentation and posterior glenohumeral capsular reconstruction, using a human acellular dermal allograft for EDS patients with multidirectional instability.