Treatment of recurrent shoulder dislocation by arthroscopic subscapularis augmentation using the long head of the biceps tendon

Abstract

Background

Recurrent anterior shoulder dislocation is a common shoulder problem, usually caused by a force from the front when the shoulder joint is abducted and externally rotated. In the present study, we investigated the effect of arthroscopic subscapularis augmentation using the long head of the biceps tendon on shoulder motion after restoring anterior stability of the joint in patients with 13.5–20% of scapular glenoid defects.

Methods

Fifty patients admitted to our department with recurrent anterior shoulder dislocation between April 2017 and July 2021 were retrospectively analyzed. The patients were divided into two groups (groups A and B, n = 25 each) with comparable age, sex, hand dominance, and articular glenoid bone loss. Patients in group A were treated with arthroscopic Bankart repair and subscapularis augmentation, whereas those in group B underwent arthroscopic long head of the biceps transposition and subscapularis augmentation. All patients in both groups were followed up for more than 1 year, with a mean follow-up period of 20.1 ± 0.7 months (range, 13–28 months). The primary outcomes were changes in the visual analog scale score, Rowe classification, and Constant–Murley shoulder outcome score.

Results

None of the patients in either group had experienced recurrent dislocation at 1-year follow-up. The visual analog scale scores decreased, and the Rowe and Constant–Murley scores improved significantly compared to the preoperative scores. Significant differences were observed in the forward flexion, abduction, and internal rotation angles of the shoulder joint in both groups at 1-year follow-up compared to baseline. The postoperative forward flexion (P = 0.143), abduction (P = 0.778), and internal rotation angles (P = 0.609) did not differ significantly between the two groups. At 1-year follow-up, the loss of angles of external rotation at the side and external rotation at 90° abduction in group B exhibited significantly less angular loss than group A.

Conclusion

Arthroscopic subscapularis augmentation using the long head of the biceps transposition technique was effective at restoring anterior stability in patients with 13.5–20% scapular glenoid defects. It was more effective at restoring the external rotational function of the shoulder joint than arthroscopic Bankart repair and subscapularis augmentation.

Keywords

biceps longus tendon subscapularis muscle bone defect arthroscopy recurrent shoulder dislocation scapular glenoid defects

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