Dynamic and Static Stabilization of Anterior Shoulder Instability With the Subscapular Sling Procedure

Abstract

There are numerous arthroscopic techniques available to address anterior shoulder instability. Complications are various, and in pursuit of new treatment options, an alternative arthroscopic technique with less potential for complications has been developed. The novel subscapular sling with a semitendinosus graft provides both dynamic and static stability. This procedure uses a semitendinosus graft as a sling around the upper two-thirds of the subscapular tendon, attached to the anterior glenoid rim. The sling phenomenon present in the Latarjet procedure was the basis of the development. The efficacy of the subscapular sling procedure has been verified in biomechanical studies and further investigated in a clinical pilot study. The procedure can be performed without altering the anatomy of nearby structures such as the coracoid process, the conjoined tendon, and the axillary and musculocutaneous nerves. The authors propose the arthroscopic subscapular sling procedure as an alternative to existing surgical treatment options for recurrent anterior shoulder instability.

Transglenoid Fixation Technique for Arthroscopic Subscapularis Augmentation Using an Adjustable-Length Loop Cortical Suspensory Fixation Device

“…In contrast, Klungsøyr et al. 9 verified that the loop had no adverse effect on sliding of the subscapularis tendon with the arm in abduction. Because there are virtually nonexistent glenohumeral ligaments in chronic recurrent dislocation, shoulder stabilization has to involve the subscapularis tendon, 7 we performed most of the described surgeries without Bankart repair.…”

“…The technique for subscapularis tenodesis is different from that of Klungsøyr et al. 9 and Maiotti and Massoni. 10 The graft is not doubled, and there is no graft on the rim of the glenoid anteriorly.…”

“…As a result, the transplant graft in front of the subscapularis tendon used as the sling is placed around the upper part of the subscapularis, and then the subscapularis is pulled posteriorly to the anterior glenoid rim ( Fig 7 ). 9

Fig 7 MRI showing use of the transplant graft in front of the subscapularis tendon as a sling, placed around the upper part of the subscapularis. (a) The tendon is in front of the SSc, from coronal view.

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“…Postoperatively, the shoulder is immobilized with dynamic shoulder immobilization in a special sling, 9 , 10 , 11 and external rotation is limited to neutral and 30° of abduction for 6 weeks. Passive shoulder range of motion (ROM) exercises is used to increase joint mobility, and pendulum exercises and wrist and hand exercises are permitted during this time.…”

“…There are 3 new techniques based on that reported by Johnson: using part of the subscapularis tendon, which is detached from the distal part and fixed at the anterior glenoid rim 8 ; stabilizing the shoulder with a tendon graft and enhancing the anterior rim of the glenoid with the same graft 9 ; and augmenting the anterior capsulolabral tissue using the articular portion of the subscapularis tendon and knotless suture anchors paired with high-strength tape for its fixation to the anterior glenoid edge. 10 Several studies have shown the advantages of anterior soft-tissue augmentation, 3 , 9 , 10 , 11 and for anterior shoulder instability with moderate GBL, it is an effective procedure without any significant differences from the open Latarjet procedure. 6 …”