Arthroscopic autograft reconstruction of the inferior glenohumeral ligament: Exploration of technical feasibility in cadaveric shoulder specimens

Abstract

Failure of primary arthroscopic Bankart repair in anterior–inferior glenohumeral instability is low, but in some cases revision surgery is required. Revision procedures show good to excellent results but typically are done open and do not respect the anatomical functionality of the joint capsule. The purpose of this cadaveric study was to explore the feasibility of a completely arthroscopic anatomical reconstruction of the inferior glenohumeral ligament using a hamstring autograft.

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

“…In addition, only the anterior capsuloligamentous complex—more specifically, the middle glenohumeral ligament and anterior band of the IGHL—was reconstructed. In contrast, the configuration proposed by Bouaicha and Moor 23 that aims to reconstruct both the posterior and anterior bands of the IGHL has the advantage of accurately reproducing the inferior ligamentous “hammock” and thus its biomechanical properties.…”

“…Previously, glenohumeral ligament reconstruction techniques have been described as salvage procedures for chronic anteroinferior instability after failed surgery 19, 20, 21, 22. Recently, Bouaicha and Moor 23 presented an all-arthroscopic IGHL reconstruction technique in a cadaveric study as a proof of concept. A hamstring autograft was applied in a triangular configuration to re-create the anteroinferior restraint of the IGHL.…”

Arthroscopic Posterior Glenohumeral Capsular Augmentation With Gracilis Tendon Allograft

“…Many novel reconstruction techniques have been proposed to address the difficult problem of recurrent shoulder instability. Anterior reconstruction techniques have been described using graft from the iliotibial band,18, 19 Achilles tendon,20, 21 hamstring tendon,22, 23, 24 tibialis anterior tendon allograft,8, 16 split subscapularis tendon flap, 25 and more recently, acellular human dermal allograft capsular reconstruction 26, 27. An alternative anterior augmentation approach describes using a folded porcine skin surgical mesh membrane to reconstruct the anterior glenoid labrum and create a voluminous anterior bumper 28 …”

Labral Repair Augmentation by Labroplasty and Simultaneous Trans-Subscapular Transposition of the Long Head of the Biceps

“…To prevent recurrence, numerous methods have been proposed, such as the application of allografts and augmentation by part of the tendon of the subscapular muscle. 9 , 10 , 11 Boytchev, 12 in 1951, described transposition of the conjoint tendon with the tip of the coracoid process through the subscapularis and fixation of the tendon to its original anatomic position. Latarjet, 13 in 1954, described transposition of the conjoint tendon with the coracoid process through splitting of the subscapularis and fixation of the coracoid process to the scapular neck with a screw for shoulder stabilization.…”

“…To prevent recurrence, numerous methods have been proposed, such as the application of allografts and augmentation by part of the tendon of the subscapular muscle 9, 10, 11. Boytchev, 12 in 1951, described transposition of the conjoint tendon with the tip of the coracoid process through the subscapularis and fixation of the tendon to its original anatomic position.…”