Dynamic Anterior Stabilization of the Shoulder With Adjustable-Loop Device

ABSTRACT: Dynamic anterior stabilization of the shoulder is a surgical procedure based on a triple soft-tissue block. This procedure is designed to fit within a gray zone between the Bristow-Latarjet procedure and the Bankart procedure, where the patient would not need a bone graft; however, capsular reconstruction alone may be insufficient to yield reliable stabilization. This article describes dynamic anterior stabilization of the shoulder using the adjustable-loop device. Technique Video Video 1 Dynamic anterior stabilization of shoulder with adjustable-loop device. Blunt dissection is performed using a Kelly device in the direction of the fibers of the shoulder capsule and subscapularis tendon. A bipolar radiofrequency device is used to widen this split of the capsule and subscapularis, allowing instrumentation through the anteroinferolateral portal. A 4-point 5-mm drill is inserted anteriorly by using a specific guide for dynamic anterior stabilization, and a hole is created from anterior to posterior. The blunt end of a perforated Kirschner wire is used to pass a blue nylon guidewire from anterior to posterior. The long head of the biceps (LHB) tendon is cut in a region where this tendon can move through the bicipital groove with no problems by using a thin basket inserted through the anterior portal. A nylon wire is inserted into the biceps to establish a landmark. Just proximal to the pectoralis major tendon, the LHB is found. It is pulled out of the bicipital groove by use of a regular probe. The tendon is pulled out of the body through the anteroinferolateral portal by use of an arthroscopic grasper. A Krackow suture is placed in the biceps. The nylon guidewire passes the polyester adjustable-loop device’s guide through the hole from anterior to posterior. The adjustable-loop device is carefully fixed on the posterior aspect of the scapula. A fluoroscopic examination can ensure that the adjustable-loop device is fixed on the posterior surface of the scapula. The high-resistance wire sutured in the LHB is passed through the adjustable-loop device loops. With the scope in the posterior portal, one can see this high-resistance wire through the adjustable-loop device loops. The biceps is pulled through the subscapularis split and sutured to these loops. Now, the LHB is ready to be pulled into the hole of the anterior glenoid rim. The adjustable-loop device loops will bring the LHB into the bone. All sutured part of the tendon will need to be into the bone. The adjustable-loop device wires are cut, and the LHB is transferred. A soft-tissue anchor is inserted inferior to the biceps to suture the inferior labrum. Another soft-tissue anchor is inserted to suture the superior labrum. Postoperative radiographs will confirm the position of the adjustable-loop device. The posterior and anterior portals can be visualized.

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PROVIDER: S-EPMC9939554 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature