A new subscapular sling operation to stabilize the shoulder. A cadaver study

Abstract

IntroductionA new arthroscopic shoulder stabilisation procedure is proposed, which for some patients could be an alternative to the arthroscopic Latarjet procedure.MethodsThe objective was to stabilize the shoulder by making a sling around the subscapularis tendon, using a hamstring graft and enhancing the anterior rim of the glenoid with the same graft. The anatomical feasibility of the surgical procedure was tested to establish the surgical method.ResultsFour surgeons performed the surgery on six cadavers. After the surgery the cadavers were dissected to visualize the result. The sling was placed according to the intention and the nerves in the area (axillary and musculocutaneus) were not at risk, nor had they altered position during the procedure.ConclusionThe procedure is technically feasible and the risk of complications seems low. This procedure could be an alternative to the Latarjet procedure and to other operations used for anterior instability of the shoulder. A biomechanical study will be performed as the next stage of the development.Clinical relevanceThis procedure could be an alternative to the Latarjet procedure and to other operations used for anterior instability of the shoulder.Trial registration2012/1978/REK sør-øst

The novel arthroscopic subscapular quadriceps tendon–bone sling procedure provides increased stability in shoulder cadavers with severe glenoid bone loss

“…An intact subscapular tendon is crucial to achieve a stabilizing effect. In contrast to the subscapular tenodesis performed in the Putti–Platt procedure [ 36 ] and other techniques described recently [ 7 , 24 ], the subscapular tendon–bone sling achieves a combination of both dynamic and static stabilization without a tenodesis of the subscapular tendon [ 20 ] which may prevent over constraint and subsequently, secondary arthrosis. In a previous study of the ST subscapular sling [ 37 ], the graft was fixated in 0° of abduction and neutral rotation and a significant reduction in external rotational range of motion at 60° of abduction was observed.…”

“…The importance of this sling phenomenon has been well described in cadaveric studies [ 11 , 40 , 43 ]. The subscapular sling procedure with semitendinosus (ST) graft [ 20 ] has recently been developed, whereby a sling around the upper part of the subscapular tendon is constructed using a ST graft. As a result, this procedure does not alter the anatomy to as large a degree as the Latarjet procedure [ 20 ].…”

“…The subscapular sling procedure with semitendinosus (ST) graft [ 20 ] has recently been developed, whereby a sling around the upper part of the subscapular tendon is constructed using a ST graft. As a result, this procedure does not alter the anatomy to as large a degree as the Latarjet procedure [ 20 ]. When performing the ST sling procedure, all the instrument handling takes place lateral to the conjoined tendon, which potentially reduces the risk of harm to nerves and vessels.…”

Arthroscopic Bone Graft Procedure Combined With Arthroscopic Subscapularis Augmentation for Recurrent Anterior Instability With Glenoid Bone Defect

“… 34 In 2015, the first short-term follow-up series reported very good clinical results with recurrences of 2.5% without impairment of external rotation. 35 The sling effect of the upper subscapularis tenodesis was described, 47 and its function as an anterior barrier in recentering the humeral head was shown in a biomechanical study on specimens. 38 In a contemporary publication of a multicenter study, the reproducibility of this combination of the Bankart repair and the ASA technique was confirmed showing good results relative to failures without compromising external rotation.…”

Dynamic and Static Stabilization of Anterior Shoulder Instability With the Subscapular Sling Procedure

“…[6][7][8][9][10][11] The potential for better treatment options led to the development of the subscapular sling with a semitendinosus (ST) graft. 12,13 Feasibility and biomechanical cadaveric studies have been performed, 12,13 and a clinical pilot study of the subscapular sling shows promising preliminary results. The purpose of this paper is to present the surgical procedures involved in the subscapular sling method with an ST graft.…”