Advertisement

Conjoined Tendon Transfer for Traumatic Anterior Glenohumeral Instability in Patients With Large Bony Defects and Anterior Capsulolabral Deficiency

      Purpose

      To report outcomes of a conjoined tendon transfer procedure in a small case series of young active patients of various activity levels with recurrent traumatic anterior shoulder instability.

      Methods

      A retrospective chart review identified 10 consecutive patients who underwent conjoined tendon transfer (8 open and 2 arthroscopic) for anterior glenohumeral instability from January 2009 through December 2012. The indications were traumatic anterior shoulder instability with 25% or greater anterior glenoid bone loss, engaging Hill-Sachs lesion, or absent anterior-inferior labral tissue with anterior capsular tissue that did not readily hold sutures or a combination of these deficiencies. Patients did not undergo the procedure if they had healthy capsulolabral tissue and small bony defects or if they competed in high-level collision sports or were overhead throwers. The American Shoulder and Elbow Surgeons (ASES) questionnaire and a physical examination were completed preoperatively. Postoperatively, patients answered questions about shoulder stability and completed ASES and Western Ontario Shoulder Index questionnaires. A physical examination was performed postoperatively to assess range of motion.

      Results

      Of 10 patients, 9 were available for follow-up. The mean age was 33.0 years (range, 18-51 years) at the time of surgery. Eight of nine patients underwent a physical examination at 31.3 ± 10.5 months (range, 24-58 months) postoperatively. There were no revisions or complications except for recurrent instability in 1 patient who underwent the arthroscopic procedure and reported gross deviation from the postoperative protocol. The ASES score improved significantly (62.8 ± 21.2 at baseline vs 89.2 ± 11.5 at final follow-up, P = .01). The postoperative Western Ontario Shoulder Index score was 74.5 ± 19.7. No significant change was found in external rotation in 90° of abduction (80.6° ± 12.9° at baseline vs 88.4° ± 6.1° at final follow-up, P = .11) or in flexion (145.6° ± 14.9° at baseline vs 153.1° ± 16.4° at final follow-up, P = .19). All patients returned to their previous activity level.

      Conclusions

      Stability was restored and no significant range-of-motion loss was observed in noncollision athletes who underwent conjoined tendon transfer. Recurrent instability occurred in 1 patient who underwent the arthroscopic procedure. There were no other complications.

      Level of Evidence

      Level IV, therapeutic case series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Griesser M.J.
        • Harris J.D.
        • McCoy B.W.
        • et al.
        Complications and re-operations after Bristow-Latarjet shoulder stabilization: A systematic review.
        J Shoulder Elbow Surg. 2013; 22: 286-292
        • Longo U.G.
        • Loppini M.
        • Rizzello G.
        • Ciuffreda M.
        • Maffulli N.
        • Denaro V.
        Latarjet, Bristow, and Eden-Hybinette procedures for anterior shoulder dislocation: Systematic review and quantitative synthesis of the literature.
        Arthroscopy. 2014; 30: 1184-1211
        • Schmid S.L.
        • Farshad M.
        • Catanzaro S.
        • Gerber C.
        The Latarjet procedure for the treatment of recurrence of anterior instability of the shoulder after operative repair: A retrospective case series of forty-nine consecutive patients.
        J Bone Joint Surg Am. 2012; 94: e75
        • Burkhart S.S.
        • De Beer J.F.
        • Barth J.R.
        • Cresswell T.
        • Roberts C.
        • Richards D.P.
        Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss.
        Arthroscopy. 2007; 23: 1033-1041
        • Tasaki A.
        • Morita W.
        • Yamakawa A.
        • et al.
        Combined arthroscopic Bankart repair and coracoid process transfer to anterior glenoid for shoulder dislocation in rugby players: Evaluation based on ability to perform sport-specific movements effectively.
        Arthroscopy. 2015; 31: 1693-1701
        • Hovelius L.
        • Sandstrom B.
        • Olofsson A.
        • Svensson O.
        • Rahme H.
        The effect of capsular repair, bone block healing, and position on the results of the Bristow-Latarjet procedure (study III): Long-term follow-up in 319 shoulders.
        J Shoulder Elbow Surg. 2012; 21: 647-660
        • Lo I.K.
        • Parten P.M.
        • Burkhart S.S.
        The inverted pear glenoid: An indicator of significant glenoid bone loss.
        Arthroscopy. 2004; 20: 169-174
        • Athwal G.S.
        • Meislin R.
        • Getz C.
        • Weinstein D.
        • Favorito P.
        Short-term complications of the arthroscopic Latarjet procedure: A North American experience.
        Arthroscopy. 2016; 32: 1965-1970
        • Bhatia S.
        • Frank R.M.
        • Ghodadra N.S.
        • et al.
        The outcomes and surgical techniques of the Latarjet procedure.
        Arthroscopy. 2014; 30: 227-235
        • Allain J.
        • Goutallier D.
        • Glorion C.
        Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder.
        J Bone Joint Surg Am. 1998; 80: 841-852
        • Burkhart S.S.
        • De Beer J.F.
        Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion.
        Arthroscopy. 2000; 16: 677-694
        • Larrain M.V.
        • Montenegro H.J.
        • Mauas D.M.
        • Collazo C.C.
        • Pavon F.
        Arthroscopic management of traumatic anterior shoulder instability in collision athletes: Analysis of 204 cases with a 4- to 9-year follow-up and results with the suture anchor technique.
        Arthroscopy. 2006; 22: 1283-1289
        • Roberts S.N.
        • Taylor D.E.
        • Brown J.N.
        • Hayes M.G.
        • Saies A.
        Open and arthroscopic techniques for the treatment of traumatic anterior shoulder instability in Australian rules football players.
        J Shoulder Elbow Surg. 1999; 8: 403-409
        • Panchal A.P.
        • Osbahr D.C.
        • Douoguih W.
        • Parks B.G.
        Conjoined tendon transfer vs modified Bristow in a glenoid bone loss model: A biomechanical study.
        Orthop J Sports Med. 2013; 1 (2325967113S00012)
        • Thomas P.R.
        • Parks B.G.
        • Douoguih W.A.
        Anterior shoulder instability with Bristow procedure versus conjoined tendon transfer alone in a simple soft-tissue model.
        Arthroscopy. 2010; 26: 1189-1194
        • Yamamoto N.
        • Muraki T.
        • An K.N.
        • et al.
        The stabilizing mechanism of the Latarjet procedure: A cadaveric study.
        J Bone Joint Surg Am. 2013; 95: 1390-1397
        • May Jr., V.R.
        A modified Bristow operation for anterior recurrent dislocation of the shoulder.
        J Bone Joint Surg Am. 1970; 52: 1010-1016
        • Helfet A.J.
        Coracoid transplantation for recurring dislocation of the shoulder.
        J Bone Joint Surg Br. 1958; 40: 198-202
        • Hovelius L.
        • Vikerfors O.
        • Olofsson A.
        • Svensson O.
        • Rahme H.
        Bristow-Latarjet and Bankart: A comparative study of shoulder stabilization in 185 shoulders during a seventeen-year follow-up.
        J Shoulder Elbow Surg. 2011; 20: 1095-1101
        • Lombardo S.J.
        • Kerlan R.K.
        • Jobe F.W.
        • Carter V.S.
        • Blazina M.E.
        • Shields Jr., C.L.
        The modified Bristow procedure for recurrent dislocation of the shoulder.
        J Bone Joint Surg Am. 1976; 58: 256-261
        • Ettinger M.
        • Dratzidis A.
        • Hurschler C.
        • et al.
        Biomechanical properties of suture anchor repair compared with transosseous sutures in patellar tendon ruptures: A cadaveric study.
        Am J Sports Med. 2013; 41: 2540-2544
        • Hinse S.
        • Menard J.
        • Rouleau D.M.
        • Canet F.
        • Beauchamp M.
        Biomechanical study comparing 3 fixation methods for rotator cuff massive tear: Transosseous No. 2 suture, transosseous braided tape, and double-row.
        J Orthop Sci. 2016; 21: 732-738
        • Mountney J.
        • Senavongse W.
        • Amis A.A.
        • Thomas N.P.
        Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction.
        J Bone Joint Surg Br. 2005; 87: 36-40
        • Marder R.A.
        • Timmerman L.A.
        Primary repair of patellar tendon rupture without augmentation.
        Am J Sports Med. 1999; 27: 304-307
        • Boileau P.
        • Mercier N.
        • Roussanne Y.
        • Thelu C.E.
        • Old J.
        Arthroscopic Bankart-Bristow-Latarjet procedure: The development and early results of a safe and reproducible technique.
        Arthroscopy. 2010; 26: 1434-1450
        • Boileau P.
        • Bicknell R.T.
        • El Fegoun A.B.
        • Chuinard C.
        Arthroscopic Bristow procedure for anterior instability in shoulders with a stretched or deficient capsule: The “belt-and-suspenders” operative technique and preliminary results.
        Arthroscopy. 2007; 23: 593-601
        • Lafosse L.
        • Lejeune E.
        • Bouchard A.
        • Kakuda C.
        • Gobezie R.
        • Kochhar T.
        The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability.
        Arthroscopy. 2007; 23: 1242-1245
        • Yamamoto N.
        • Itoi E.
        • Abe H.
        • et al.
        Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: A new concept of glenoid track.
        J Shoulder Elbow Surg. 2007; 16: 649-656

      Linked Article