Shoulder instability is a relatively common problem. Even with contemporary surgical techniques, instability can recur following both open and arthroscopic fixation. Surgical management of capsular insufficiency in anterior shoulder stabilization represents a significant challenge, particularly in young, active patients. There are a limited number of surgical treatment options. The Laterjet technique can present with a number of intraoperative challenges and postoperative complication.
Description of Technique
We report an arthroscopic subscapularis tenodesis technique as a salvage procedure for challenging glenohumeral instability cases. Sutures are passed through the subscapularis tendon and capsule before they are tied as one in the subdeltoid psace. The rotator interval is closed with superior and medial advancement of anterior and inferior tissue. This technical note carefully describes this procedure with useful technical tips, illustrations, and diagrams.
Patients and Methods
Two clinical cases are described involving patients with recurrent instability following failed surgery who were successfully managed with this procedure.
Both cases described resulted in improved shoulder stability, range of motion, and function following management with this surgical technique. This arthroscopic subscapularis tenodesis procedure is proposed as a useful alternative repair technique for cases of recurrent instability after failed surgery with isolated capsular insufficiency.
It is believed that this arthroscopic subscapularis tenodesis technique can potentially provide similar outcomes to open bone block stabilization procedures, while reducing the risks associated with those procedures.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Allain J, Goutallier D, et al. Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am. 1998; 80A(6): 841-852.
Boileau P, Mercier N, et al. Arthroscopic Bankart–Bristow–Latarjet procedure: the development and early results of a safe and reproducible technique. Arthroscopy J Arthroscopic Related Surg. 2010; 26(11): 1434-1450.
Boileau P, Richou J, et al. The role of arthroscopy in revision of failed open anterior stabilization of the shoulder. Arthroscopy J Arthroscopic Related Surg. 2009; 25(10): 1075-1084.
Boileau P, Villalba M, et al. Risk factors for recurrence of shoulder instability after arthroscopic bankart repair. J Bone Joint Surg A. 2006; 88(8): 1755-1763.
Burkhart SS, De Beer JF, et al. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy J Arthroscopic Related Surg. 2007; 23(10): 1033-1041.
Dines J. The “at risk” position for anterior shoulder instability. San Diego: American Shoulder and Elbow Society Speciality Day; 2011.
Dodson C, Dines JS, et al. Biomechanical analysis comparing the modified Latarjet procedure with a novel subscapularis tenodesis technique in a cadaveric anterior shoulder instability model. Providence, Rhode Island: American Orthopaedic Society for Sports Medicine; 2010.
Edwards TB, Walch G. The latarjet procedure for recurrent anterior shoulder instability: rationale and technique. Oper Techn Sport Med. 2002; 10(1): 25-32.
Gartsman GM, Roddey TS, et al. Arthroscopic treatment of anterior–inferior glenohumeral instability. Two to five-year follow-up. J Bone Joint Surg Am- Series A. 2000; 82(7): 991-1003.
Hovelius L, Sandstrom B, et al. One hundred eighteen Bristow–Latariet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: study I—clinical results. J Shoulder Elb Surg. 2004; 13(5): 509-516.
Hovelius LK, Sandstrom BC, et al. Long-term results with the Bankart and Bristow–Latarjet procedures: recurrent shoulder instability and arthropathy. J Shoulder Elb Surg. 2001; 10(5): 445-452.
Lafosse L, Boyle S. Arthroscopic Latarjet procedure. J Shoulder Elb Surg. 2010; 19(2 SUPPL): 2-12.
Laurencin CT, Deutch A, et al. The superolateral portal for arthroscopy of the shoulder. Arthroscopy. 1994; 10(3): 255-258.
Maynou C, Cassagnaud X, et al. Function of subscapularis after surgical treatment for recurrent instability of the shoulder using a bone-block procedure. J Bone Joint Surg British Volume. 2005; 87B(8): 1096-1101.
O’Brien SJ, Miller AN, et al. Arthroscopic subdeltoid approach to the biceps transfer. Oper Techn Sport Med. 2007; 15(1): 20-26.
Owens BD, Duffey ML, et al. The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med. 2007; 35(7): 1168-1173.
Piasecki DP, Verma NN, et al. Glenoid bone deficiency in recurrent anterior shoulder instability: diagnosis and management. J Am Acad Orthop Surg. 2009; 17(8): 482-493.
Spoor AB, Malefijt JD. Long-term results and arthropathy following the modified Bristow–Latarjet procedure. Int Orthop. 2005; 29(5): 265-267.
Tauber M, Resch H, et al. Reasons for failure after surgical repair of anterior shoulder instability. J Shoulder Elb Surg. 2004; 13(3): 279-285.
Voos JE, Livermore RW, et al. Prospective evaluation of arthroscopic bankart repairs for anterior instability. Am J Sports Med. 2010; 38(2): 302-307.
Young AA, Maia R, et al. Open Latarjet procedure for management of bone loss in anterior instability of the glenohumeral joint. J Shoulder Elb Surg. 2011; 20(2): S61-S69.
Conflict of Interest:
Salma Chaudhury, MD, Christopher C. Dodson, MD, Demetris Delos, MD, David W. Altchek, MD, Ashley M. Newman, BA, and Stephen J. O’Brien, MD, MBA have declared that they have no conflict of interest. Joshua S. Dines, MD is a paid consultant for Biomimetics, Conmed, and Phussis, outside the work.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed consent was waived from all patients for being included in the study.
Required Author Forms
Disclosure forms provided by the authors are available with the online version of this article.
About this article
Cite this article
Chaudhury, S., Delos, D., Dines, J.S. et al. Arthroscopic Subscapularis Bankart Technique as a Salvage Procedure for Failed Anterior Shoulder Stabilization. HSS Jrnl 10, 73–78 (2014). https://doi.org/10.1007/s11420-013-9370-8
- anterior shoulder stabilization
- Bankart repair
- shoulder instability