All-Arthroscopic, 270° Reconstruction of the Inferior Glenohumeral Ligament With Palmaris Longus Autograft

Abstract

Numerous factors play a role in anterior shoulder stability. The inferior glenohumeral ligament, especially the anterior band, is the main passive anterior stabilizer in the end range of motion. Surgical treatment of this pathology continues to be a challenge in patients with capsular deficiency, in whom the recurrence rate of soft-tissue arthroscopic repair increases significantly. There is not yet a fair solution for these patients without glenoid bone loss, in whom the poor tissue quality determines recurrent instability. We present an all-arthroscopic technique for reconstruction of the inferior glenohumeral ligament by means of palmaris longus autograft as an alternative to nonanatomic bone block procedures.

Current Evidence Regarding Shoulder Instability in the Paediatric and Adolescent Population

“…Case reports are available describing the use of tendon graft to reconstruct the IGHL arthroscopically [121][122][123][124]. Techniques vary, but the general intention is to reconstruct both the anterior and posterior bands of the IGHL to recreate the deficient inferior sling of the glenohumeral joint.…”

“…Techniques vary, but the general intention is to reconstruct both the anterior and posterior bands of the IGHL to recreate the deficient inferior sling of the glenohumeral joint. IGHL reconstruction shows promising results in those with severe MDI and ligamentous laxity who have failed other forms of surgical intervention [121][122][123][124]. More research is needed to confirm the safety and long-term efficacy of this technique.…”

Current Evidence in Shoulder Instability in the Paediatric and Adolescent Population

“…Case reports are available describing the use of tendon graft to reconstruct the IGHL arthroscopically [107][108][109][110]. Techniques vary but general intention is to reconstruct both the anterior and posterior bands of the IGHL, to recreate the deficient inferior sling of the glenohumeral joint.…”

“…Techniques vary but general intention is to reconstruct both the anterior and posterior bands of the IGHL, to recreate the deficient inferior sling of the glenohumeral joint. IGHL reconstruction shows promising results in those with severe MDI and ligamentous laxity, who have failed other forms of surgical intervention [107][108][109][110]. More research is needed to confirm the safety and long-term efficacy of this technique.…”

Editorial Commentary: Augmented Bankart Could Be the Right Option for Subcritical Bone Loss

“…Since my goal is not to reproduce their original anatomy (that previously failed), I consequently devised for this specific type of patients a new Bankart augmentation technique involving the long head of the biceps. 6 Currently, a myriad of Bankart augmentation methods exists, including capsular shift, 7 remplissage, 8,9 dynamic anterior stabilization, 6,10 closing rotator interval, 11,12 a split subscapularis tendon flap, 13 a reconstruction of the inferior glenohumeral ligament, 14 etc. All these different techniques have several pros and cons, making it difficult to decide which one to use in clinical practice.…”