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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.

SUBMITTER: Klungsoyr JA

PROVIDER: S-EPMC8322630 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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

Klungsøyr Jan Arild JA Vagstad Terje T Klungsøyr Peter Johannes PJ Hellevik Alf Inge AI Drogset Jon Olav JO

Arthroscopy techniques 20210620 7

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 ...[more]

PMID: 34336575

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Project description:PurposeTo assess independent predictors of surgery after an emergency department visit for shoulder instability, including patient-related and socioeconomic factors.MethodsPatients presenting to the emergency department were identified in the New York Statewide Planning and Research Cooperative System database from 2015 to 2018 by International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for anterior shoulder dislocation or subluxation. All shoulder stabilization procedures in the outpatient setting were identified using Current Procedural Terminology codes (23455, 23460, 23462, 23466, and 29806). A multivariable logistic regression was performed to assess the impact of patient factors on the likelihood of receiving surgery. The variables included in the analysis were age, sex, race, social deprivation, Charlson Comorbidity Index, recurrent dislocation, and primary insurance type.ResultsIn total, 16,721 patients with a shoulder instability diagnosis were included in the analysis and 1,028 (6.1%) went on to have surgery. Patients <18 years old (odds ratio [OR] 8.607, P < .0001), those with recurrent dislocations (OR 2.606, P < .0001), or worker's compensation relative to private insurance (OR 1.318, P = .0492) had increased odds of receiving surgery. Hispanic (OR 0.711, P = .003) and African American (OR 0.63, P < .0001) patients had decreased odds of surgery compared with White patients. Patients with Medicaid (OR 0.582, P < .0001) or self-pay (OR 0.352, P < .0001) insurance had decreased odds of undergoing surgery relative to privately insured patients. Patients with greater levels of social deprivation (OR 0.993, P < .0001) also were associated with decreased odds of surgery.ConclusionsAnterior glenohumeral instability and subsequent stabilization surgery is associated with disparities among patient race, primary insurance, and social deprivation.Clinical relevanceConsidering the relationship between differential care and health disparities, it is critical to define and increase physician awareness of these disparities to help ensure equitable care.

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

Publications

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

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