Arthroscopic Subscapularis Bankart Technique as a Salvage Procedure for Failed Anterior Shoulder Stabilization

Abstract

Background

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.

Results

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.

Conclusion

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.

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Disclosures

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.

Human/Animal Rights:

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:

Informed consent was waived from all patients for being included in the study.

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Correspondence to Salma Chaudhury MD.

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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

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Keywords

  • anterior shoulder stabilization
  • subscapularis
  • Bankart repair
  • shoulder instability
  • arthroscopic
  • tenodesis