Glenoid bone loss is commonly associated with recurrent shoulder instability. Failure to recognize and appropriately address it can lead to poor outcomes. Numerous studies have found anterior-inferior glenoid bone loss in the setting of recurrent anterior instability. Though much less common, posterior shoulder instability can be seen in the setting of acute trauma, epilepsy, electrocution, and alcoholism. Heightened awareness has led to recognition in collision athletes as well. Posterior glenoid bone loss must be addressed in a similar fashion to anterior glenoid bone loss to prevent recurrent instability. Open bone augmentation procedures have been described with successful results. In this technical note, we describe an arthroscopic technique using fresh distal tibial allograft for posterior glenoid augmentation. In addition, a current review regarding the diagnosis and management of recurrent posterior shoulder instability is provided.
The purpose of this study was to evaluate the outcomes of patients undergoing subpectoral biceps tenodesis for bicipital tendonitis with a superior labral anterior-posterior (SLAP) tear. Patients undergoing primary subpectoral biceps tenodesis for arthroscopically confirmed SLAP tears with signs or findings of bicipital tendonitis were included. An independent observer collected data prospectively as part of a data repository, which was then analyzed retrospectively. Primary outcome measures were the American Shoulder and Elbow Surgeons (ASES) score and pain relief via visual analog scale (VAS). Secondary outcome measures included the Simple Shoulder Test (SST), Constant, Single Assessment Numeric Evaluation (SANE), and Short Form 12 (SF-12) scores. Twenty-eight patients with a mean±SD age of 43.7±13.4 years and a mean±SD follow-up of 2.0±1.0 years met inclusion criteria. Workers' compensation was involved with 43% of cases, and 46% of the included patients were manual laborers. Eight (32%) patients were athletes, and 88% of the athletes were overhead athletes. Intraoperatively, 15 (54%) patients had type I SLAP tears, 10 (36%) had type II SLAP tears, 1 (3%) had a type III SLAP tear, and 2 (7%) had type IV SLAP tears. Significant improvements were seen in the following outcome measures pre- vs postoperatively: ASES score (58±23 vs 89±18; P=.001), SST score (6.3±3.6 vs 10.6±3.3; P=.001), SANE score (54±24 vs 88±25; P=.003), VAS score (3.8±2.0 vs 1.1±1.8; P=.001), SF-12 overall score (35±6 vs 42±6; P=.001), and SF-12 physical component score (39±6 vs 50±10; P=.001). Overall satisfaction was excellent in 80% of patients. Subpectoral biceps tenodesis demonstrates excellent clinical outcomes in select patients with SLAP tears. [Orthopedics. 2015; 38(1):e48-e53.].
Objectives:Superior Labrum Anterior-Posterior (SLAP) lesions are a common cause of shoulder pain, however, their diagnosis, classification, and treatment remains controversial. The purpose of this study was to evaluate the outcomes of patients undergoing subpectoral biceps tenodesis as a salvage intervention for failed type II SLAP repair. We hypothesized that patients undergoing subpectoral biceps tenodesis for failed type II SLAP tears will demonstrate improved subjective and objective outcomes at a mean two-year follow-up.Methods:A retrospective review of prospectively collected data was performed on patients who underwent subpectoral biceps tenodesis for failed type II SLAP repair by a single surgeon between 2008 and 2010. Primary outcome measures included Visual Analog Scale (VAS), American Shoulder and Elbow Score (ASES), and Short Form-12 (SF-12) score. Secondary outcome variables included Simple Shoulder Test (SST) and Single Assessment Numeric Evaluation (SANE) Score. Demographic and intraoperative information was recorded for each patient (Table 1). A paired t-test was performed, with a P-value less than 0.05 considered statistically significant.Results:Eleven patients met the study criteria (mean age 40.2, range 22-54). Of these patients, nine completed post-operative surveys (82%) at a mean 26 month follow-up (range 15 to 49 months). Mean VAS scores improved from 4.1 to 2.5 (p=0.03), SST from 5.4 to 9.3 (p=0.005), ASES from 54.5 to 78.0 (p=0.002), and SANE score from 42.5 to 70.4 (p=0.001). SF-12 total improved from 30.5 to 36.1(p=0.06). Furthemore, the improvement in the VAS pain, ASES, and SST scores exceeded the reported minimally clinical important differences (MCID), suggesting that this intervention provided meaningful improvement for the patients (Table 2). There were no failures, perioperative, or postoperative complications, and no patients required additional surgery.Conclusion:The findings suggest that patients who undergo subpectoral biceps tenodesis as a salvage procedure for failed type II SLAP repair demonstrate improved results. To our knowledge, the results for this procedure utilized for this indication have not been reported in the literature. Larger scale comparative studies are required to further justify this technique.
Pectoralis major ruptures occur in large, muscular individuals, and repair constructs may experience significant tension. Four different suture techniques were evaluated biomechanically to determine the effect of suture technique on optimizing fixation strength. Forty fresh-frozen cadaveric shoulders were repaired using endosteal buttons. The control group was repaired with #2 polyblend suture in a modified Mason-Allen stitch configuration. The triple group was repaired using the same suture and configuration, but with the addition of triple-loaded buttons. The configuration group was repaired using the same suture in a Krackow/Bunnell configuration. The tape group was repaired using 2-mm polyethylene tape and #5 polyblend suture in the Krackow/Bunnell configuration. Under cyclic loading, there was no significant difference between groups. Under load-to-failure testing, the tape group withstood a significantly greater maximum load (726.0±90.0 N) than the control and triple groups (330.2±20.2 and 400.2±35.2 N, respectively; P<.005), and similar load to the configuration group (509.9±68.6 N; P=.16). The configuration group failed via suture breakage (9/10); the other groups failed via suture pullout, in which suture pulled through tendon (26/30). Pectoralis major repair in a running, locked configuration appears to improve biomechanical performance by preventing suture pullout. Use of a polyethylene tape construct demonstrates the potential for improved failure loads, but its role remains undefined.
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