Soft Arthroscopic Latarjet Procedure: Technical Note on Biceps Tendon as a Modified Sling for Restoration of Glenohumeral Stability

Amr Abdel-Mordy Kandeel

doi:10.1016/j.eats.2021.02.021

Abstract

As an alternate to sling glenohumeral restabilization mechanism of Latarjet procedure, recent different arthroscopic soft-tissue reconstructive techniques have been described for the management of glenohumeral instability. One of these techniques is trans-subscapularis bony tenodesis of long head of biceps (instead of coracoid graft transfer) to the anteroinferior glenoid. For simplification of the latter technique, the current article reports an alternative arthroscopic technique for management of glenohumeral instability in patients with type V SLAP lesion or poor soft-tissue quality of the anterior capsulolabral complex. In this technique, Bankart repair is followed by soft-tissue tenodesis of long head of biceps to upper border of subscapularis tendon by 2 simple stitches of non-absorbable sutures. Compared with previous ones, the currently reported technique is versatile, quick, technically simple, entirely intra-articular, and cost-saving; however, it is nonanatomic and should be investigated in biomechanical and cohort clinical studies to clarify its long-term validity.

Highlights

As an alternate to sling glenohumeral restabilization mechanism of Latarjet procedure, recent different arthroscopic soft-tissue reconstructive techniques have been described for the management of glenohumeral instability
Different arthroscopic nonbony techniques have evolved as alternatives to Latarjet procedure by gaining advantage of soft tissue structures as conjoint tendon (CT), SSC tendon and long head of biceps brachii (LHB).[9,10,11,12,13]
Taking advantage of SSC, Maiotti et al.[10] described tenodesis of upper third of SSC tendon to anterior mid-glenoid for GH capsular deficiency. This technique resulted in an average loss of 6 in external rotation with the arm aside, with concerns about impaired function of upper third of SSC

Summary

Discussion

Lafosse et al described the Latarjet procedure as a minimally invasive technique of coracoid transfer to the anteroinferior glenoid. This technique can be coupled with other restabilization procedures (e.g., Bankart repair) and its indications should be limited for management of softtissue lesions of GH instability The latter technique was modified by Collin and Lädermann,[12] who reported a similar arthroscopic tenodesis technique, into a 3-o’clock drilled hole in the anterior glenoid using a tenodesis screw. Milenin and Toussaint[13] described arthroscopic trans-SSC transposition of LHB over anteroinferior glenoid using knotless anchors fort labral augmentation/reconstruction in patients with poor soft-tissue quality of the capsulolabral complex, provided that there is no significant glenoid bone loss. These previous techniques are still somewhat complex, time-consuming, and costly (due to hardware). Additional supportive evidence might stem from a novel biomechanical study by Mehl et al.,[17] who concluded that currently evolving techniques of dynamic anterior shoulder stabilization by LHB tenodesis to the anterior glenoid were effective in restraining GH translation under tested instability conditions of up to 20% glenoid bone defects

Latarjet Procedure

Findings

Conclusions