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
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".