Arthroscopic Transfer of the Long Head of the Biceps Brachii for Anterior Shoulder Instability

Chronic traumatic anteroinferior instability is a common pathology of the shoulder joint. In case of glenoid bone defects, the Latarjet or bone block technique is the method of choice. The arthroscopic Bankart procedure and its modifications remain the preferred methods of treating patients without substantial bone damage of the glenoid and humeral head; however, there is a high recurrence of instability after the Bankart procedure, even for optimal indications. One of the main causes of recurrence is poor quality and weakness of the glenohumeral ligaments and labrum. We describe an alternative technique that provides triple mechanisms of stabilization like the Latarjet procedure. In our procedure, the long head of the biceps tendon is used for a sling effect, dynamic stabilization is achieved by trans-subscapular tenodesis with simultaneous plasty of the anterior segment of the labrum, and subsequent resuspension of the glenohumeral ligaments is performed using the same anchors. In patients without substantial bone loss, this procedure has numerous advantages over the arthroscopic Latarjet procedure. By creating triple mechanisms of stability like the Latarjet procedure (the bumper effect, reinforcement of ligaments, and sling effect), our procedure can significantly reinforce the Bankart procedure in cases of poor-quality glenohumeral ligaments.

Section: Discussionmentioning

confidence: 79%

mentioning

confidence: 99%

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

Milenin¹,

Toussaint

2019

“…Labral proprioception can also play an important and neglected role in shoulder stability 16 . We suggest that the described procedure and similar procedures17, 18 will add not only biomechanical stabilization 19 but also tendon proprioception of the LHB, and the subscapularis can also play an important role in shoulder stabilization.…”

Section: Discussionmentioning

confidence: 99%

The Long Head of the Biceps Bristow-Bankart Procedure for Anterior Shoulder Instability

Garcia¹,

Belchior²,

Mello³

et al. 2019

Surgical procedures to treat anterior shoulder instability are basically split into 2 groups: those for patients with important bone loss and those for patients with no bone loss. However, there is a gray zone between these procedures in which a bone graft would not be needed but bone grafting would result in a desirable improvement in stabilizing mechanisms. We describe a technique based on the triple soft-tissue block, Bankart reconstruction, and long head of the biceps tenodesis at the anterior glenoid rim. The long head of the biceps would add an anterior restrictor by itself, as well as by tensioning the inferior part of the subscapularis.

“…Technically, it is very difficult to combine this technique with a bone block. LHB transfer for capsular reinforcement has been described by several authors, and it improves results 8, 9. Our idea was to create a technique that combines the advantages of 2 techniques—iliac crest bone grafting and transposition of the LHB parallel to the bone block through the subscapular split.…”

Section: Discussionmentioning

confidence: 99%

“…To solve this problem, we proposed combining this technique with soft-tissue reinforcement and a simultaneous dynamic stabilization technique. A repair technique using the long head of the biceps (LHB) with trans-subscapular tenodesis to the scapular neck has been described by several authors 8, 9. This technique can significantly reinforce the capsular deficit.…”

mentioning

confidence: 99%

The Combined Arthroscopic Revision Technique After the Latarjet Procedure

Milenin¹,

Sergienko²,

Badtieva

2019

The Latarjet procedure is very popular and is the method of choice in cases of glenoid bone loss and anterior-inferior instability or revision procedures. However, recurrence is common after this procedure. One of the methods of revision after the Latarjet procedure is the Eden-Hybinette technique. However, recurrence occurs after this bone grafting procedure as well. The primary reasons for recurrence are graft resorption and capsular deficiency. To improve these outcomes, transfer of the long head of the biceps for capsular reinforcement has been recommended by several authors. We describe an all-arthroscopic procedure, performed after the Latarjet technique, that combines bone block transfer, trans-subscapular transposition of the long head of the biceps, and anterior labroplasty. This technique can significantly reinforce the deficient capsule through the sling effect and cover the graft for prophylaxis against bone resorption.