Arthroscopic Subscapularis Augmentation of Bankart Repair in Chronic Anterior Shoulder Instability With Bone Loss: Clinical Multicenter Study

Abstract

The aim of this study was to evaluate the clinical outcomes of a new arthroscopic procedure consisting of a tenodesis of the upper third of the subscapularis and a Bankart repair in chronic anterior shoulder instability with bone loss. This is a retrospective, multicenter case series study. One hundred ten patients practicing sports, who underwent arthroscopic subscapularis augmentation (ASA) of Bankart repair in chronic anterior shoulder instability with a mean follow-up of 40.5 months (range: 24 to 65 months) were enrolled for this study. The patients were operated by four different surgeons and functional outcomes were evaluated by independent observers. Preoperatively all patients underwent CT scan Pico area method to assess the percentage of glenoid bone loss (GBL). Exclusion criteria included a GBL >25%. In all patients a Hill-Sachs lesion was observed. In 24 patients a prior stabilization procedure had failed. VAS scale, Rowe score, American Shoulder and Elbow Surgeons (ASES) scores were used to assess results. No specific complications related to this procedure occurred. Three patients (2.7%), but none of 24 with failure of prior stabilization procedure, had a post-traumatic re-dislocation. At final follow-up, the mean scores were as follows: VAS scale significantly decreased from a mean of 3.5 to 0.5 (P= .015), Rowe score significantly raised from 57.4 to 95.3 (P= .035), ASES score significantly raised from 66.5 to 96.5 (P= .021). The mean deficit of external rotation was 8° with the arm in R1 position, and 4° with the arm in R2 position. This procedure has been demonstrated safe and effective to restore joint stability in patients practicing sports, affected by chronic anterior shoulder instability associated with anterior glenoid bone loss (<25%) and engaging Hill-Sachs lesions. Level of evidence: IV, case series, treatment study.