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.
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Article info
Publication history
Published online: August 23, 2017
Accepted:
June 19,
2017
Received:
December 9,
2016
Footnotes
See commentary on page 21
The authors report the following potential conflict of interest or source of funding: W.A.D. receives support from Arthrex. Arthrex provided anchors and suture to perform the surgical procedures. He is an Ultimaxx Health board member with 1% ownership stake. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2017 Published by Elsevier on behalf of the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: We Need to Customize Surgical Treatment When Treating Patients With Recurrent Anterior Shoulder InstabilityArthroscopyVol. 34Issue 1
- PreviewSurgical repair of shoulder instability is challenging, and multiple procedures have been proposed. In an attempt to reduce risk of recurrence following surgical reconstruction, some surgeons have added steps to prior arthroscopic procedures, and other surgeons have selected a bone reinforcement procedure. These additional augmented repair techniques have reduced the risk of postoperative recurrence, but introduced additional risk of complications related to hardware, fixation, and possible need for additional surgery.
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