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
ARTICLE HIGHLIGHTS
Research 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.

Research motivation

To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis in the treatment of anterior shoulder instability.

Research objectives

To seek a method to enhance anterior stability and reduce the recurrence rate.

Research methods

Patients with a glenoid defect < 20% underwent an arthroscopic Bankart repair combined with a subscapularis upper one-third tenodesis. Arthroscopic iliac crest bone autograft for the patients with a glenoid defect > 20% underwent an arthroscopic iliac crest bone autograft combined with a subscapularis upper one-third tenodesis. All patients were assessed with Rowe and Constant scores.

Research 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. When abduction was 90°, the average external rotation angle was 68.4° ± 13.6° and 88.5° ± 6.2°, 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 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.

Research conclusions

Arthroscopy combined with subscapularis upper one-third tenodesis was shown to be effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect, enhanced the anterior stability of the shoulder, and did not affect the postoperative range of motion of the affected limb. This method is simple, and the selection of patients, proficiency of the surgical procedure, and postoperative functional exercises are the key to the success of the operation.

Research perspectives

We decided not only to repair the torn labrum or reconstruct the bony structure, but also to enhance the anterior shoulder stability with subscapularis tenodesis augmentation in the treatment of recurrent anterior shoulder instability.