Lupine Publishers | Orthopedics and Sports Medicine Open Access Journal (OSMOAJ)
Abstract
Background: Recurrent anterior shoulder dislocation is a very common problem that face the orthopedic surgeon, which affects young people in their life, especially the professional workers or athletes and military persons. They may need either arthroscopic or open procedure to obtain a stable shoulder. Arthroscopic Bankart repair is the most popular technique used, but there is a high recurrence rate in patients either with labral tear or glenoid bone loss more than 25%. Bankart repair depends on the presence of a capsule stretching and /or attenuation which is reported in patients with a chronic recurrent shoulder dislocation. The purpose of this study is to explain the technique that we used to reconstruct the labral defect in recurrent shoulder dislocation by using Biceps Brachii tendon as auto graft.
Methods: Four patients with history of recurrent shoulder dislocation underwent shoulder arthroscopy using the long head of Biceps as autograft in our department with average follow up 21 months (range,18 - 26 months) after the operation. All the patients had history of recurrent shoulder dislocation. We evaluated them according to clinical examinations and radiological investigations including X-ray and MRI. In this paper we explain our arthroscopic technique using long head of Biceps Brachii as a graft to cover anterior glenoid in cases of unreconstructedly labrum.
Results: The patients
who underwent arthroscopic surgery using this technique had a significant improvement, pain free range of motion were normal forward flexion 170˚ - 180˚, abduction 90˚, external rotation with abduction 90˚, with normal flexion of elbow, normal supination and pronation. Apprehension test post-operative was negative, and improvement DASH score 14.5 to 16.5. The patients return to do their daily activities normally.
Conclusion: Using Biceps tendon as autograft to cover the labral defect will do the same work of the labrum to form a bumper by deepening the socket so the ball will be in its place, for this reason we repair the capsule and the Biceps tendon to restore shoulder instability with less side effects when comparing with conjoined tendon transfer and it is a simple procedure.
Keywords: Recurrent Shoulder Instability; Bankart Repair; Biceps Brachii Autograft; Latarjet Procedure
Introduction
Discussion
Recurrent anterior shoulder dislocation is a common pathology in active young patients, most of the cases treated surgically either by arthroscopy or open. Arthroscopy when there is detachment of the capsule -labral injury. Latarjet is a procedure for restore shoulder stability by the sling effect of conjoined tendon [8], in cases of significant bone loss of the anterior glenoid rim. Recurrence rate for the Bankart procedure alone range up to 37.5% among patients with poor labrum tissue or glenoid rim erosion or in high-impact athletes [9,10]. Many studies show that there are several factors which considered as a reason for high rate of failure as professional players who need forceful external rotation and abduction, younger age and those with soft tissue and bone defects [11,20]. A soft tissue procedure is also better tolerated when in contact with humeral head and avoid most of the complications of the coracoid bone attached to the glenoid like nonunion [12], graft resorption [13,14] and graft migration12. One of the disadvantages of Latarjet procedure is destroyed the coracoacromial arch which may result superior instability [6,7]. Repairing the labrum and restoration of capsular tension should be done in same session to get more anatomic procedure and to reduce the recurrence rate [15,16].
The patients who underwent arthroscopic surgery using this technique have a significant improvement, pain free range of motion are normal forward flexion is 170˚-180˚, abduction 90˚, external rotation with abduction is 90˚, with formal flexion of elbow, normal supination and pronation. Apprehension test post-operative is negative, and improvement DASH score 14.5 to 16.5. The patients return to do their daily activities normally. This study describes a new technique that can be used in patients with unrepairable labrum and with small bone loss from the glenoid, which may help the patients to avoid other operations as Latrajet procedure. Repair of labrum and restoration of capsular tension should be done together so as to perform a more anatomic procedure and reduce the recurrence rate [21,22]. In our technique we use the biceps tendon to replace the labrum and restore of capsular tension to reduce the recurrence rate. The number of patients is low because of the situation of covid-19 and we closed the operation theater in our department for many times.
Conclusion
Using Biceps tendon as autograft to cover the labral defect will do the same work of the labrum to form a bumper by deepening the socket so the ball will be in its place, for this reason we repair the capsule and the Biceps tendon to restore shoulder instability with less side effects when comparing with conjoined tendon transfer and it is a simple procedure. We believe that the contraindication of this technique is rupture of the Biceps tendon
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