Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2022; 10(25): 8854-8862
Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.8854
Arthroscopy with subscapularis upper one-third tenodesis for treatment of recurrent anterior shoulder instability independent of glenoid bone loss
Bai-Jing An, Feng-Lin Wang, Yao-Ting Wang, Zhe Zhao, Ming-Xin Wang, Geng-Yan Xing
Bai-Jing An, Feng-Lin Wang, Yao-Ting Wang, Zhe Zhao, Ming-Xin Wang, Department of Sports Medicine, The Fourth Medical Center, PLA General Hospital, Beijing 100048, China
Feng-Lin Wang, Department of Clinical Laboratory, The Third Medical Center, PLA General Hospital, Beijing 100039, China
Geng-Yan Xing, Department of Orthopedics, The Third Medical Center, PLA General Hospital, Beijing 100039, China
Author contributions: An BJ and Wang FL wrote the manuscript; An BJ and Wang YT collected data for review; all authors treated patients; all authors read and approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by The Third Medical Center of the Chinese People's Liberation Army General Hospital Medical Ethics Committee (approval No. KY2021-034).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng-Lin Wang, MD, PhD, Professor, Department of Clinical Laboratory, The Third Medical Center, PLA General Hospital, No. 69 Yongding Road, Beijing 100039, China. gcp_wjzyy@tom.com
Received: February 16, 2022
Peer-review started: February 16, 2022
First decision: June 7, 2022
Revised: June 16, 2022
Accepted: July 22, 2022
Article in press: July 22, 2022
Published online: September 6, 2022
Processing time: 190 Days and 18.4 Hours
Abstract
BACKGROUND

Recurrent anterior shoulder instability is a common traumatic injury, the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head. The current follow-up study showed that the effect of arthroscopic Bankart repair is unreliable.

AIM

To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis for treatment of anterior shoulder instability, and to develop a method to further improve anterior stability and reduce the recurrence rate.

METHODS

Between January 2015 and December 2018, male patients with recurrent anterior shoulder instability were selected. One hundred and twenty patients had a glenoid defect < 20% and 80 patients had a glenoid defect > 20%. The average age was 25 years (range, 18–45 years). Patients with a glenoid defect < 20% underwent arthroscopic Bankart repair with a subscapularis upper one-third tenodesis. The patients with a glenoid defect > 20% underwent an arthroscopic iliac crest bone autograft with a subscapularis upper one-third tenodesis. All patients were assessed with Rowe and Constant scores.

RESULTS

The average shoulder forward flexion angle was 163.6° ± 8.3° and 171.8° ± 3.6° preoperatively and at the last follow-up evaluation, respectively. The average external rotation angle when abduction was 90° was 68.4° ± 13.6° and 88.5° ± 6.2° preoperatively and at the last follow-up evaluation, respectively. The mean Rowe scores preoperatively and at the last follow-up evaluation were 32.6 ± 3.2 and 95.2 ± 2.2, respectively (P < 0.05). The mean Constant scores preoperatively and at the last follow-up evaluation were 75.4 ± 3.5 and 95.8 ± 3.3, respectively (P < 0.05). No postoperative dislocations were recorded by the end of the follow-up period.

CONCLUSION

Arthroscopy with subscapularis upper one-third tenodesis was effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect, enhanced anterior stability of the shoulder, and did not affect postoperative range of motion of the affected limb.

Keywords: Arthroscopy; Subscapularis; Iliac crest bone autograft; Recurrent anterior shoulder instability; Glenoid bone loss

Core Tip: Arthroscopy combined with subscapularis upper one-third tenodesis was effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect, enhanced anterior stability of the shoulder, and did not affect the postoperative range of motion of the affected limb.