Abstract
Purpose
The 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).
Methods
A 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.
Results
No 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.
Conclusion
For 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 evidence
III.
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References
Braun S, Horan MP, Millett PJ (2011) Open reconstruction of the anterior glenohumeral capsulolabral structures with tendon allograft in chronic shoulder instability. Oper Orthop Traumatol 23(1):29–36
Burkart AC, Debski RE (2002) Anatomy and function of the glenohumeral ligaments in anterior shoulder instability. Clin Orthop Relat Res 400:32–39
Butt U, Charalambous CP (2013) Arthroscopic coracoid transfer in the treatment of recurrent shoulder instability: a systematic review of early results. Arthroscopy 29(4):774–779
Chaudhury S, Delos D, Dines JS, Altchek DW, Dodson CC, Newman AM et al (2014) Arthroscopic subscapularis Bankart technique as a salvage procedure for failed anterior shoulder stabilization. HSS J 10(1):73–78
Cole BJ, Romeo AA (2001) Arthroscopic shoulder stabilization with suture anchors: technique, technology, and pitfalls. Clin Orthop Relat Res 390:17–30
Dewing CB, Horan MP, Millett PJ (2012) Two-year outcomes of open shoulder anterior capsular reconstruction for instability from severe capsular deficiency. Arthroscopy 28(1):43–51
Gartsman GM, Roddey TS, Hammerman SM (2000) Arthroscopic treatment of anterior-inferior glenohumeral instability: two to five-year follow-up. J Bone Joint Surg Am 82:991–1003
Gerometta A, Rosso C, Klouche S, Hardy P (2016) Arthroscopic Bankart shoulder stabilization in athletes: return to sports and functional outcomes. Knee Surg Sports Traumatol Arthrosc 24(6):1877–1883
Kalogrianitis S, Tsouparopoulos V (2016) Arthroscopic iliac crest bone block for reconstruction of the glenoid: a fixation technique using an adjustable-length loop cortical suspensory fixation device. Arthrosc Tech 5(6):e1197–e1202
Kim S-J, Kim S-H, Park B-K, Chun Y-M (2014) Arthroscopic stabilization for recurrent shoulder instability with moderate glenoid bone defect in patients with moderate to low functional demand. Arthroscopy 30(8):921–927
Klungsøyr P, Guldal F, Vagstad T, Klungsøyr J (2015) A new subscapular sling operation to stabilize the shoulder. A cadaver study. J Exp Orthop 2(1):12
Lo IK, Lind CC, Burkhart SS (2004) Glenohumeral arthroscopy portals established using an outside–In technique: neurovascular anatomy at risk. Arthroscopy 20(6):596–602
Longo UG, Loppini M, Rizzello G, Ciuffreda M, Berton A, Maffulli N et al (2014) Remplissage, humeral osteochondral grafts, weber osteotomy, and shoulder arthroplasty for the management of humeral bone defects in shoulder instability: systematic review and quantitative synthesis of the literature. Arthroscopy 30(12):1650–1666
Maiotti M, Russo R, Zanini A, Schröter S, Massoni C, Bianchedi D (2016) Arthroscopic Bankart repair and subscapularis augmentation: an alternative technique treating anterior shoulder instability with bone loss. J Shoulder Elbow Surg 25(6):898–906
Owens BD, Duffey ML, Nelson BJ, DeBerardino TM, Taylor DC, Mountcastle SB (2007) The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med 35(7):1168–1173
Brzóska R, Laprus H, Michniowski P, et al (2019) Novel and effective arthroscopic extracapsular stabilization technique for anterior shoulder instability-BLS. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05496-1
Romeo AACB, Carreira DS (2001) Traumatic anterior shoulder instability. Orthop Clin North Am 32(3):399–409
Russo R, Della Rotonda G, Cautiero F, Ciccarelli M, Maiotti M, Massoni C et al (2017) Arthroscopic Bankart repair associated with subscapularis augmentation (ASA) versus open Latarjet to treat recurrent anterior shoulder instability with moderate glenoid bone loss: Clinical comparison of two series. Musculoskelet Surg 101(1):75–83
Russo R, Maiotti M, Taverna E (2018) Arthroscopic bone graft procedure combined with arthroscopic subscapularis augmentation (ASA) for recurrent anterior instability with glenoid bone defect: a cadaver study. J Exp Orthop 5(1):5
Schröter S, Krämer M, Welke B, Hurschler C, Russo R, Herbst M, et al. (2016) The effect of the arthroscopic augmentation of the subscapularis tendon on shoulder instability and range of motion: a biomechanical study. Clin Biomech (Bristol, Avon) 38:75–83
Steffen V, Hertel R (2013) Rim reconstruction with autogenous iliac crest for anterior glenoid deficiency: forty-three instability cases followed for 5–19 years. J Shoulder Elbow Surg. 22(4):550–559
Tang J, Zhao J (2018) Arthroscopic transfer of the conjoined tendon-coracoid tip complex for anterior shoulder instability. Arthrosc Tech 7(1):e33–e38
Voos JE, Livermore RW, Feeley BT, Altchek DW, Williams RJ, Warren RF et al (2010) Prospective evaluation of arthroscopic Bankart repairs for anterior instability. Am J Sports Med 38(2):302–307
Wellmann M, Smith T, Petersen W, Siebert CH, Agneskirchner JD, Hurschler C (2012) Biomechanical investigation of the stabilization principle of the Latarjet procedure. Arch Orthop Trauma Surg 132(3):377–386
Funding
This study was supported by Sanming Project of Medicine in Shenzhen (Grant No. SZSM201612078).
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IRB approval was obtained (Peking University Shenzhen Hospital, approval, ID: 201768).
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Ren, S., Zhang, X., Zhou, R. et al. Arthroscopic subscapularis augmentation combined with capsulolabral reconstruction is safe and reliable. Knee Surg Sports Traumatol Arthrosc 27, 3997–4004 (2019). https://doi.org/10.1007/s00167-019-05648-3
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DOI: https://doi.org/10.1007/s00167-019-05648-3