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Arthroscopic subscapularis bankart technique as a salvage procedure for failed anterior shoulder stabilization.

ABSTRACT:

Background

Shoulder instability is a relatively common problem. Even with contemporary surgical techniques, instability can recur following both open and arthroscopic fixation. Surgical management of capsular insufficiency in anterior shoulder stabilization represents a significant challenge, particularly in young, active patients. There are a limited number of surgical treatment options. The Laterjet technique can present with a number of intraoperative challenges and postoperative complication.

Description of technique

We report an arthroscopic subscapularis tenodesis technique as a salvage procedure for challenging glenohumeral instability cases. Sutures are passed through the subscapularis tendon and capsule before they are tied as one in the subdeltoid psace. The rotator interval is closed with superior and medial advancement of anterior and inferior tissue. This technical note carefully describes this procedure with useful technical tips, illustrations, and diagrams.

Patients and methods

Two clinical cases are described involving patients with recurrent instability following failed surgery who were successfully managed with this procedure.

Results

Both cases described resulted in improved shoulder stability, range of motion, and function following management with this surgical technique. This arthroscopic subscapularis tenodesis procedure is proposed as a useful alternative repair technique for cases of recurrent instability after failed surgery with isolated capsular insufficiency.

Conclusion

It is believed that this arthroscopic subscapularis tenodesis technique can potentially provide similar outcomes to open bone block stabilization procedures, while reducing the risks associated with those procedures.

SUBMITTER: Chaudhury S

PROVIDER: S-EPMC3903943 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundManagement of failed anterior stabilization is difficult. There are two main options for revision either a revision labral repair which has published high failure rates because of poor quality capsulolabral tissues or a bone block/Latarjet procedure with associated morbidity and complication rates. On this background, the senior author (D.T.) has developed a new procedure to treat this difficult to manage clinical scenario.AimThe aim of this study was to evaluate the 2-year results of an arthroscopic conjoint tendon transfer procedure. The procedure has previously been developed to provide a potential solution for active patients with a failed labral repair, subcritical glenoid bone loss, and an on-track Hill-Sachs lesion.MethodsConsecutive patients who fulfilled the inclusion criteria were prospectively recruited. Inclusion criteria were active patients with recurrent shoulder instability owing to failed labral repair, less than 10% anterior glenoid bone loss, and an on-track Hill Sachs lesion. Patients were fully consented and offered a choice of revision with an arthroscopic labral repair, a Latarjet procedure or the arthroscopic conjoint tendon transfer procedure. Preoperative and postoperative Western Ontario Shoulder Instability Index and Oxford Instability Score were collected.ResultsEight patients met the inclusion criteria and opted for the conjoint tendon transfer procedure. Mean age was 35 with a male:female ratio of 7:1. No patients had hyperlaxity clinically. At median follow-up of 31 months (range 24-41), there was a significant improvement in both the median Western Ontario Shoulder Instability Index (53.7 to 13.4, P = .0003) and Oxford Instability Score (27 to 44.5, P = .0017) scores. No patient had a further dislocation, and all were able to resume contact and noncontact sports.ConclusionOur results at a minimum of 2-year follow-up demonstrate that the arthroscopic transfer of the conjoint tendon confers clinical stability in patients with a failed primary labral repair who have minimal bone loss.