A new subscapular sling operation to stabilize the shoulder. A cadaver study

P J Klungsøyr, F Guldal, T Vagstad, J A Klungsøyr, P J Klungsøyr, F Guldal, T Vagstad, J A Klungsøyr

Abstract

Introduction: A new arthroscopic shoulder stabilisation procedure is proposed, which for some patients could be an alternative to the arthroscopic Latarjet procedure.

Methods: The objective was to stabilize the shoulder by making a sling around the subscapularis tendon, using a hamstring graft and enhancing the anterior rim of the glenoid with the same graft. The anatomical feasibility of the surgical procedure was tested to establish the surgical method.

Results: Four surgeons performed the surgery on six cadavers. After the surgery the cadavers were dissected to visualize the result. The sling was placed according to the intention and the nerves in the area (axillary and musculocutaneus) were not at risk, nor had they altered position during the procedure.

Conclusion: The procedure is technically feasible and the risk of complications seems low. This procedure could be an alternative to the Latarjet procedure and to other operations used for anterior instability of the shoulder. A biomechanical study will be performed as the next stage of the development.

Clinical relevance: This procedure could be an alternative to the Latarjet procedure and to other operations used for anterior instability of the shoulder.

Trial registration: 2012/1978/REK sør-øst.

Keywords: Arthroscopic sling procedure; Cadaver study; Hamstring graft; Shoulder instability; Subscapularis tendon.

Figures

Fig. 1
Fig. 1
Drawing of the sling
Fig. 2
Fig. 2
Arthroscopic pictures showing the preparation of the subscapularis tendon. a: Dissecting the anterior surface of the tendon from the upper portal. b: From the inferior portal. c: The point of entry for the slit in the subscapularis tendon from inside. d: The trocar advanced through the slit. Abbreviations: SST: Subscapularis tendon. HH: Humeral head. G: Glenoid. P: Portal
Fig. 3
Fig. 3
Arthroscopic pictures showing the introduction of the graft. a: The graft has been pulled in towards the glenoid anchor through the portal. b: The portal is withdrawn. c and d: The portal is placed anterior and superior to the subscapularis tendon and the graft is pulled out through the upper portal. Abbreviations: SST: Subscapularis tendon. HH: Humeral head. G: Glenoid. Gr: Graft. P: Portal
Fig. 4
Fig. 4
Arthroscopic pictures of the final placement of the graft seen from inside. a: The upper leg is fixed to the glenoid with the first suture, the second suture goes into the upper portal. b and c: The upper part of the graft placed on the anterior ridge of glenoid. Abbreviations: SST: Subscapularis tendon. HH: Humeral head. G: Glenoid. Gr: Graft. P: Portal
Fig. 5
Fig. 5
Post-operative pictures. a: Portal placed through the conjoined tendon. b: Correct portal placement. c: The musculocutaneus nerve is seen in the reflected conjoined tendon/muscle. The axillary nerve is seen in the fatty tissue
Fig. 6
Fig. 6
Post-operative pictures: a and b: Placement of the sling. c: Supraspinatus and the anterior part of the inferior capsule is cut. The sling holds the head in the glenoid cavity. Abbreviation: SST: Subscapularis tendon

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