Arthroscopic Augmentation With Subscapularis Tendon in Anterior Shoulder Instability With Capsulolabral Deficiency

Abstract

The treatment of chronic shoulder instability with poor quality of the anterior capsulolabral tissue is still controversial. In these cases the Latarjet procedure is certainly more effective in preventing recurrence than an arthroscopic capsular repair. However, several studies have reported a variety of severe complications related to the Latarjet procedure because of the use of bone augmentation and hardware implantation; moreover, the arthroscopic version of the Latarjet procedure is technically difficult and potentially dangerous because of the proximity of neurovascular structures. The aim of this report is to describe an innovative arthroscopic technique consisting of an augmentation of the anterior capsulolabral tissue using the articular portion of the subscapularis tendon and knotless suture anchors paired with high-strength tape for its fixation to the anterior glenoid edge. In the absence of severe bone deficiency of the anterior glenoid edge, this procedure can minimize arthroscopic technique failures, restoring the anterior capsulolabral wall without any significant reduction of shoulder functionality.

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

“… 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. 36 …”

“…The upper third of the subscapularis tendon—as described in the Maiotti technique 38 —is usually fixed at 3 (R) or 9 (L) o'clock positions on the glenoid neck. In this technique, the tenodesis bone holes are placed on the anterior glenoid edge in an upper position, slightly over the top of the glenoid edge (at 10 o'clock in the left shoulders and 2 o'clock in the right shoulders), to avoid possible interference with the upper glenoid tunnel used for the fixation of the graft ( Fig 13 ).…”

“…Considering the recent positive experience using partial subscapularis tenodesis on the glenoid rim, known as arthroscopic subscapularis augmentation (ASA), 37 , 38 , 39 , 40 , 41 to treat recurrent anterior instability with capsular inconsistence and moderate GBL, we decided to apply both techniques—free bone block and ASA (arthroscopic subscapularis augmentation and bone block)—in the treatment of severe GBL (10% to 25%) associated with anterior capsular insufficiency.…”

Modified Latarjet Procedure Without Capsulolabral Repair for Failed Previous Operative Stabilizations

“…However, especially in patients with multiple recurrences or previous procedures, the anteroinferior capsulolabral complex is often very stretched or deficient, putting in doubt the effectiveness of these reconstructions. 4 , 5 In addition, cadaveric and biomechanical studies have shown that capsular repair is not necessary to achieve the desired stability with the Latarjet procedure. 6 , 7 …”

Anterior Capsular Reconstruction for Irreparable Subscapularis Tears

“…In cases in which a repair is not possible, few options remain for the treatment of these patients. Several surgical techniques, both nonanatomic 6 and anatomic, 7 , 8 , 9 , 10 , 11 have attempted to reconstruct the anterior glenohumeral capsule and the subscapularis muscle in this context. The results have varying rates of success and may be associated with altered biomechanics, high retear rates, and complications such as nerve injury.…”