Stabilisation of medial shoulder instability by imbrication of the subscapularis muscle tendon of insertion

Abstract

Subscapularis muscle tendon of insertion imbrication is a moderately effective procedure for the management of medial shoulder instability unresponsive to medical and/or arthroscopic management. The angle of abduction of the shoulder was returned to normal in model of medial shoulder instability, following subscapularis muscle tendon of insertion. Subscapularis muscle tendon of insertion imbrication provides a relatively simple method of treating medial shoulder instability in dogs.

Feasibility and safety of arthroscopic medial glenohumeral ligament and subscapularis tendon repair with knotless anchors: A cadaveric study in dogs

“…Having multiple fixation points might be especially important when suturing damaged tissue. Our technique also included the subscapularis tendon because (1) it is one of the most commonly affected structures in medial shoulder instability and (2) a subscapularis imbrication technique via open approach has been previously described …”

“…The medial and lateral glenohumeral ligaments, the joint capsule, and the articular surfaces act as static stabilizers . To maintain shoulder stability, the integrity of the medial glenohumeral ligament (MGHL) and the subscapularis tendon is essential . Franklin et al reported a relative distribution with 78% of the cases presenting with medial, 8% with lateral, and 15% showing a multidirectional instability.…”

“…Nonprosthetic reconstruction aims at increasing tension of medial anatomical structures without the use of a prosthetic ligament and includes imbrication of the subscapularis tendon and radiofrequency‐induced thermal capsulorraphy . Both techniques are described with good outcome . Radiofrequency generates heat in the tissue, causing initial loss of mechanical properties caused by collagen denaturation and cell necrosis, resulting in a reparative response.…”

“…14 Both techniques are described with good outcome. 3,8,15 Radiofrequency generates heat in the tissue, causing initial loss of mechanical properties caused by collagen denaturation and cell necrosis, resulting in a reparative response. The reparative response includes inflammation, repair by fibroblasts, and remodeling of tissue.…”

Operative Arthroscopy

“…Consequently, consideration should be given to performing open surgery, repairing torn or stretched structures. Imbrication of the subscapularis tendon of insertion and placement of prosthetic ligaments anchored to anatomic sites of origin and insertion have each been described for the successful management of medial instability of the shoulder joint (Pettitt et al, 2007). Biceps tendon transposition is also a useful and effective technique to restore medial shoulder stability.…”