Multidirectional Shoulder Instability: Arthroscopic Labral Augmentation

Abstract

Capsulolabral augmentation is one of the most used arthroscopic techniques to address multidirectional instability of the shoulder. Given the thin and weak capsule seen in the affected patients, reconstruction in this subset of patients can be particularly challenging. This arthroscopic technique aims to reduce the capsular volume and deepen the glenoid socket through the creation of a particularly voluminous "bumper" along the glenoid bone. Increasing the depth of the glenoid facilitates a concavity-compression stabilizing effect and, therefore, shoulder stability, especially midrange stability. This technique aims to augment the bump of the standard capsulolabral reconstruction by using a resorbable surgical mesh derived from porcine skin.

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

“… 2 , 14 , 21 After anterior dislocation of the shoulder joint, the circular structure of the labrum fibers becomes disrupted and impossible to repair completely; therefore, the treatment option is plasty of the joint labrum with autograft and allograft, which is effective. 17 The disadvantage of this technique is that it requires a large number of anchor fixators and sutures, which can damage the cartilage. The procedure is also technically demanding, complicated, and requires allograft or autograft harvesting.…”

“…The Bankart procedure is the preferred method for acute uncomplicated cases and good-quality glenohumeral ligaments 2, 14, 21. After anterior dislocation of the shoulder joint, the circular structure of the labrum fibers becomes disrupted and impossible to repair completely; therefore, the treatment option is plasty of the joint labrum with autograft and allograft, which is effective 17 . The disadvantage of this technique is that it requires a large number of anchor fixators and sutures, which can damage the cartilage.…”

“… 15 , 16 Other authors showed the effectiveness of a labroplasty with an allograft or autograft. 17 Nicola 18 described transposition using the long head of the biceps through the bone tunnel in the humeral head for shoulder stabilization. Historically, in the Union of Soviet Socialist Republics, the Vainstein procedure, which consists of superficial medial transposition of the tendon of the long biceps head under the tendon of the subscapularis, has been very popular.…”

“…Several authors proposed the use of dynamic stabilization by transposition of the long biceps head tendon for additional stabilization in the repair of Bankart injury and fixation in the bone channel with the suture button or Bio-Tenodesis anchor 15, 16. Other authors showed the effectiveness of a labroplasty with an allograft or autograft 17 . Nicola 18 described transposition using the long head of the biceps through the bone tunnel in the humeral head for shoulder stabilization.…”

Arthroscopic Posterior Glenohumeral Capsular Augmentation With Gracilis Tendon Allograft

“…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 …”