Arthroscopic subscapularis augmentation combined with capsulolabral reconstruction is safe and reliable

Abstract

PurposeThe study aimed to compare modified arthroscopic subscapularis augmentation (MASA) with tenodesis of the upper third of the subscapularis tendon using a tendon combined with capsulolabral reconstruction (Group A) or Bankart repair (Group B) for recurrent anterior shoulder instability (RASI). MethodsA retrospective series of 49 patients underwent primary surgery for RASI with glenoid bone loss (GBL) < 25%. Outcomes included the Oxford Shoulder Instability Score (OSIS), Visual Analogue Scale (VAS) score, Rowe score, and American Shoulder and Elbow Surgeons (ASES) functional outcome scale score. Recurrent instability, sports activity level, and range of motion (ROM) were also analysed. ResultsNo significant differences were observed at baseline. Forty‐six patients were available for more than 2 years of follow‐up. At the last follow‐up after surgery, the patients in both groups had experienced significant improvements in all outcome scores (P < 0.05 for all), and obvious decreases in forward flexion and external rotation were noted in both groups (P < 0.05 for all). Group A had superior ASES scores, VAS scores, and OSISs (P < 0.05) but did not experience significant differences in either the Rowe score or ROM compared to Group B. Group A had lower rates of recurrent instability and superior outcomes for the return to sports activities. One patient in Group A had subluxation, and 4 patients in Group B had dislocation or subluxation. No patients in either group experienced neurovascular injury, joint stiffness, or surgical wound infection. ConclusionFor RASI with GBL < 25%, MASA with tenodesis of the upper third of the subscapularis tendon using a tendon combined with capsulolabral reconstruction was a safe technique that produced better outcomes in terms of ASES scores, VAS scores, OSISs, the return to sports, and postoperative recurrent instability and did not decrease the ROM compared to that achieved by arthroscopic Bankart repair. Level of evidenceIII.

Previously failed Bankart repair and the duration from first dislocation to surgery were the risk factors associated with the level of return to sports after coracoid transfer

“…Nowadays there are many procedures (i.e. revision Bankart repair, remplissage of Hill‐Sachs lesions, arthroscopic subscapularis augmentation, Bristow–Latarjet procedure) available to revise a failed Bankart, depending on the remaining soft tissue and the bipolar bone loss [5, 12, 22]. For athletes with high demand for sports, the Bristow–Latarjet procedure may be an appropriate approach because soft tissue surgery has higher failure rates [4, 18, 24].…”

Arthroscopic Xenograft With Cerclage Fixation: A Method for Glenoid Bone Loss Reconstruction With Cerclage Fixation Using a Specific Posterior Guide

“…In particular augmentation with the upper third of the subscapularis tendon produces an additional triple effect: addressing the stretched portion of the subscapularis tendon, always present in chronic shoulder instability; amending capsular insufficiency; and restoring the physiological coracohumeral ligament tension without causing external rotation restriction. 26 , 27 , 28 , 29 , 30 Furthermore, by augmentation of the subscapularis on the glenoid neck, it is possible to get better covering of the xenograft. Moreover, the previously countered graft reduces the surgical time and avoids the possible mismatching of the handmade holes with the glenoid tunnels.…”

“…The glenoid drill holes were performed by a specific posterior guide (Arthrex, Naples, FL). After the glenoid reconstruction procedure, an arthroscopic subscapularis augmentation (ASA) 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 was performed ( Video 1 ).…”

Arthroscopic Subscapularis Augmentation Using the Long Head of the Biceps Tendon for Anterior Shoulder Instability

“…To effectively and conveniently improve the stability of the glenohumeral joint and avoid shoulder range of motion limitation and injury to the subscapularis, 33 , 34 , 35 , 36 we introduce the ASA-LHBT technique. Compared with the classic ASA with tenodesis of the upper third subscapularis at the anterior border of the glenoid rim, 37 the LHBT was used to pass through and press down on the musculotendinous junction of the upper third of the subscapularis in ASA-LHBT. The advantage of this technique includes inward and outward mobility of the subscapularis along the muscle fiber direction when the glenohumeral joint rotates.…”