All-arthroscopic inferior glenohumeral ligament reconstruction with gracilis tendon graft can successfully restore stability and function in predominantly inferior and multidirectional instability patients with hyperlaxity

Purpose: To report the early clinical and radiographic outcomes of an arthroscopic technique to reconstruct the inferior glenohumeral ligament (IGHL) to stabilize the glenohumeral joint in patients with predominantly inferior and multidirectional instability and hyperlaxity. Methods: Between October 2019 and March 2023, patients with unidirectional (inferior) or multidirectional instability with hyperlaxity, as assessed by a positive Gagey hyperabduction test with instability severity index score >3, IGHL lesions on cross-sectional imaging (magnetic resonance imaging or magnetic resonance angiography) or on arthroscopy, without glenoid bone loss, and with a minimum 12-month follow-up, were enrolled. All patients had symptomatic instability, a positive Gagey hyperabduction test (>105°) on clinical examination, and unsuccessful physical therapy. All patients underwent all-arthroscopic reconstruction of the IGHL using a gracilis tendon graft. Clinical outcomes (Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH]; Western Ontario Shoulder Instability [WOSI]; and Subjective Shoulder Value [SSV]) and radiographic evaluation were reported. Results: Thirty-one shoulders in 30 patients (mean age, 27 ± 6.5 years) at a mean 2.4 years postoperatively (range, 1-8 years) were evaluated. The mean SSV (preoperative 50.0 to 89.6, P = .016), QuickDASH (preoperative 76.5 to 42.7, P = .008), and WOSI scores (preoperative 1,355.9 to 491.5, P = .016) improved significantly. Thirty of 31 patients (97%) met the minimal clinically important difference for SSV, 28 of 31 (90%) for QuickDASH, and 29 of 31 (94%) for WOSI score. There were no instability events noted postoperatively. There were no perioperative complications. One patient underwent reoperation at 15 months to release adhesions and long head of the biceps tenodesis. Six of 31 patients had grade 1 instability arthropathy at final follow-up. One patient had a static inferiorly subluxated humeral head at the final follow-up and an inferior clinical result. Conclusions: At a minimum 12-month follow-up, an all-arthroscopic reconstruction of the IGHL with a gracilis tendon graft in hypermobile patients with predominantly inferior instability and without glenoid bone loss yielded promising clinical and radiographic results. Level of Evidence: Level IV, retrospective case series.