Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.8854
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
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.
To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis in the treatment of anterior shoulder instability.
To seek a method to enhance anterior stability and reduce the recurrence rate.
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.
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.
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.
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.