Arthroscopic subscapularis augmentation combined with capsulolabral reconstruction is safe and reliable

Background A type VIII superior labrum anterior posterior lesion represents pathologic posteroinferior extension of a type II superior labrum anterior posterior lesion with injury to the insertion of the posterior band of the inferior glenohumeral ligament. No reports in the literature describe arthroscopic treatment of a type VIII superior labrum anterior posterior lesion and its associated glenohumeral instability. Hypothesis Arthroscopic capsulolabral reconstruction is effective in alleviating pain and restoring stability and function in athletes with glenohumeral instability due to the type VIII superior labrum anterior posterior lesion. Study Design Case series; Level of evidence, 4. Methods From 2003 to 2006, 23 shoulders in 23 athletes were diagnosed with a type VIII superior labrum anterior posterior lesion by physical examination, magnetic resonance arthrography, and arthroscopy. All were treated with an arthroscopic capsulolabral reconstruction. Ten patients were involved in rehabilitation less than 9 months after surgery and were not included in this study. Thirteen remaining shoulders in 13 athletes with a mean age of 27.8 ± 10.9 years were analyzed at a mean follow-up of 24 months. Shoulders were evaluated preoperatively and postoperatively using the American Shoulder and Elbow Surgeons scoring system and standard subjective scales for stability, strength, function, and range of motion. Results Athletes most commonly participated in sport at the recreational level (n = 8), followed by collegiate (n = 3) and high school (n = 2). The most common activity was weight lifting (n = 4). Eight athletes (62%) participated in contact sports, most commonly football and wrestling. Two patients (15%) had a partial-thickness articular-sided supraspinatus tendon tear that was debrided at the time of surgery. Mean American Shoulder and Elbow Surgeons score improved from 51.4 to 90.0 (P < .001). There were significant improvements in stability, pain, function, and range of motion based on standardized subjective scales (P < .001). No shoulder required revision surgery for recurrent instability. All patients were able to return to sports, with 9 (69%) able to return to their highest level before surgery. Conclusion Arthroscopic capsulolabral reconstruction is an effective and reliable treatment for glenohumeral instability due to a type VIII superior labrum anterior posterior lesion in the contact, noncontact, and throwing athlete. Successful postoperative return to sport is a reasonable expectation.

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Outcomes of capsulolabral reconstruction for posterior shoulder instability

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2017.08.002 ◽

2017 ◽

Vol 103 (8) ◽

pp. S189-S192 ◽

Cited By ~ 9

Author(s):

K. Andrieu ◽

J. Barth ◽

M. Saffarini ◽

P. Clavert ◽

A. Godenèche ◽

...

Keyword(s):

Shoulder Instability ◽

Posterior Shoulder Instability ◽

Posterior Shoulder ◽

Capsulolabral Reconstruction

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Anterior Capsulolabral Reconstruction with Semitendinosus Autograft after Latarjet Failure: A Case Report

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i07.2290 ◽

2021 ◽

Vol 11 (7) ◽

Author(s):

Angelo De Carli ◽

Antonio P Vadalà ◽

Gianluca Fedeli ◽

Marco Scrivano ◽

Edoardo Gaj ◽

...

Keyword(s):

Case Report ◽

Shoulder Instability ◽

Recurrent Dislocation ◽

Anterior Dislocation ◽

Left Shoulder ◽

Salvage Procedure ◽

Tissue Quality ◽

Coracoid Transfer ◽

Glenohumeral Ligaments ◽

Capsulolabral Reconstruction

Introduction: The treatment of chronic shoulder instability, associated with poor tissue quality, remains challenging in the setting of anterior capsular deficiency. There are a few viable alternatives in the end-stage shoulder instability when multiple surgical attempts to correct the pathology have failed. The purpose of the present paper is to demonstrate the efficacy of anterior capsular reconstruction with semitendinosus autograft for the management of capsulolabral deficiency without associated bone loss. Case Report: A 39-year-old female admitted in our institution with a history of recurrent atraumatic anterior dislocation of the left shoulder after three unsuccessful surgical attempts: Arthroscopic and open capsulorrhaphy and a Latarjet coracoid transfer. CT scan images showed adequate placement (flush) of the coracoid transfer without any sign of reabsorption. Reconstruction of anterior capsulolabral structure was performed using a Semitendinosus autograft. The middle and inferior glenohumeral ligaments, the more crucial ligaments for anterior-inferior shoulder stability, were effectively recreated. The patient did not suffer any recurrent dislocation or subjective symptoms of instability at the time of the final follow-up, 2 years after surgery, and the ASES score increased from 36 preoperatively to 86. Conclusion: This technique, described for the first time as a salvage procedure after Latarjet failure, could represent a safe and viable treatment option in the context of multiple ineffective surgeries. Keywords: Autograft, capsulolabral reconstruction, latarjet, recurrent shoulder instability.

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Outcomes of arthroscopic capsulolabral reconstruction for anterior instability with greater than 20% glenoid bone defects: are Latarjet procedures absolutely indicated for these patients?

Clinics in Shoulder and Elbow ◽

10.5397/cise.2019.00094 ◽

2020 ◽

Vol 23 (2) ◽

pp. 62-70 ◽

Cited By ~ 1

Author(s):

Sae Hoon Kim ◽

Whanik Jung ◽

Sung-Min Rhee ◽

Ji Un Kim ◽

Joo Han Oh

Keyword(s):

Bone Defect ◽

Shoulder Instability ◽

Bone Defects ◽

Defect Size ◽

Anterior Shoulder Instability ◽

Return To Sports ◽

Anterior Instability ◽

Recurrent Instability ◽

Capsulolabral Reconstruction

Background: Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. Methods: Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. Results: The mean glenoid bone defect size was 25.8% ± 4.2% (range, 20.4%–37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24–86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. Conclusions: Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.

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