Arthroscopic Capsular Plication for Multidirectional Shoulder Instability in Hypermobile Ehlers-Danlos Syndrome Patients

Abstract

Patients with hypermobile Ehlers-Danlos syndrome commonly present with painful shoulder disorders mostly represented by a multidirectional instability and with often painless episode of atraumatic shoulder dislocation and/or subluxation. Because of the generalized soft tissue fragility, most of the surgical treatments of shoulder instability, as the Bankart repair or the Latarjet procedure becomes not effective, exposing a risk of failure. Then, capsular plication has to be considered in order to reduce the articular joint volume and to diminish the mobility of the joint. Two main benefits of this surgical procedure are that it doesn't modify the anatomy or damage the labrum or cartilage that is healthy. The purpose of this Technical Note is to present the arthroscopic capsular plication for the treatment of patient with hypermobile Ehlers-Danlos syndrome, which is associated with a multidirectional shoulder instability.

Fig 1

First step arthroscopic exploration of the glenohumeral joint for a h-EDS patient with a multidirectional shoulder instability. A patulous and redundant inferior capsule can be visualized, and the absence of capsular labral lesion needs to be assessed. The red cross indicates the long head of the biceps, the blue cross indicates the humeral head, and the green cross indicates the glenoid cavity. The patient is positioned in a supine position, and orientation is given.

Fig 2

The red cross indicates the long head of the biceps blue cross indicates the humeral head, and the green cross indicates the glenoid cavity. The patient is positioned in the supine position and the orientation are given.

Fig 3

Realization of the first anterior capsular plication at the 4 o’clock position using the shuttle relay technique. The blue cross indicates the humeral head and the green cross indicates the glenoid cavity. The patient is positioned in supine position and orientation is given.

Fig 4

Realization of the first posterior capsular plication at the 7 o’clock position. The suture thread is passed through the posterior portal. The blue cross indicates the humeral head and the green cross indicates the glenoid cavity. The patient is positioned in supine position and orientation is given.

Fig 5

Final aspect of the anterior and posterior arthroscopic capsular plication of the glenohumeral joint. The blue cross indicates the humeral head, and the green cross indicates the glenoid cavity. The patient is positioned in a supine position, and the portal used for the arthroscope is given.