Arthroscopic Transfer of the Conjoined Tendon–Coracoid Tip Complex for Anterior Shoulder Instability

Abstract

In the treatment of anterior shoulder instability, there are various conditions in which a sling effect is needed to enhance anterior stability. The traditional Bristow-Latarjet procedure provides a sling effect but destroys or does not purposely protect the coracoacromial (CA) arch, which may result in superior instability. To preserve the CA arch and create a sling to enhance the anterior-inferior side of the shoulder, we introduce an arthroscopic technique to transfer the conjoined tendon–coracoid tip complex (CTCTC) with the intention to keep the CA ligament intact to the utmost. The indications for CTCTC transfer are patients younger than 45 years who participate in competitive sports, require forceful external rotation and abduction movements of the shoulder, and/or have capsule-ligament insufficiency. The main steps of this procedure include detaching the CTCTC, fashioning the coracoid tip to obtain a coracoid pillar, braiding the CTCTC, creating a glenoid tunnel and socket, placing a guide suture through the glenoid tunnel and subscapularis, passing the CTCTC through the subscapularis and into the glenoid socket, and performing suspension fixation of the CTCTC.

Arthroscopic subscapularis augmentation combined with capsulolabral reconstruction is safe and reliable

“…A transglenoid tunnel suture is created in a retrograde manner without risking the axillary nerve. However, blind penetration of the subscapularis using a suture retriever is a dangerous manoeuvre, but with control of the direction and position of penetration, the risk can be reduced [22]. Additionally, by advancing through the tendinous part of the subscapularis tendon, the risk of injuring the musculocutaneous nerve is reduced.…”

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

“…3 Modified techniques of Latarjet, such as the Bristow and Latarjet procedure, wherein transfer of the conjoined tendon–coracoid tip complex and others, have been reported with overall satisfactory results. 4 , 5 , 6 However, these techniques are limited by technical difficulty, with a long learning curve and risks of short-term postoperative complications, such as axillary nerve injury and coracoacromial arch damage. 7 , 8 …”

“… 9 Regrettably, the risk of vascular and nerve injury is also unavoidable in LHBT transfer. 5 The arthroscopic subscapularis augmentation (ASA) technique, which is characterized by partial tenodesis of the upper third of the subscapularis tendon in combination with Bankart repair, has been effective for treating anterior shoulder stability with less than 25% glenoid bone loss. 10 Nonetheless, its use has been reduced by the potential risks of limiting shoulder external rotation and transecting the subscapularis.…”

Double-Sling Augmentation for Anterior Shoulder Dislocation

“… 2 , 3 However, it is still uncertain whether single-sling augmentation is enough in complicated cases, especially in severe capsule-ligament defects. Thus we introduce a double-sling anterior shoulder augmentation technique that is a combined transfer of both the conjoined tendon-coracoid tip complex (CTCTC) 4 and the LHB. 5 The main indication of this technique is severe capsule ligament deficiency ( Table 1 ).…”