INTERWEAVING OR RE-ROUTING OF THE CONJOINT TENDON THROUGH THE SUBSCAPULARIS IS A RELIABLE METHOD FOR ANTERIOR SHOULDER INSTABILITY WITHOUT LABRAL TEAR OR BONE LOSS
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Keywords
Anterior Shoulder Instability, Re-Routing of Subscapularis, Dynamic Reinforcement
Abstract
Background
Recurrent anterior instability has diverse aetiologies and multiple treatment options. Bankart lesion and Hill Sachs lesion are two main recognized causes but in many cases, neither of these can be found. When Bankart lesion is found, arthroscopic Bankart repair has been accepted as treatment of choice, but instability or apprehension persisted or recurred in nearly 40 % cases. Some imitation of motion is almost invariable after the Laterjet procedure due to fixed mechanical blockage. An acceptable alternative should also be there. Interweaving or re-routing of the conjoint tendon through the Subscapularis is relatively simple operation where reinforcement is dynamic, i.e. maximum in abducted position when it is really needed.
Method
In this procedure, shoulder is exposed through the anterior approach, conjoint tendon is separated and detached along with 1 cm of coracoid process which is predrilled, the conjoint tendon is passed posteriorly first and then bought back anteriorly through the Subscapularis i.e., interwoven through it, and finally, the tip of the coracoid process is re-attached to its original position with a cancellous screw.
Results
I have used this method in 11 cases of recurrent anterior instability who did not have obvious glenoid labrum tear or bone loss and have found satisfactory results without complications for two years in 10 patents; one patients was lost in follow-up.
Conclusion
If no specific aetiology is found on MRI or the facility of shoulder arthroscopy is lacking, re-routing of conjoint tendon can be a good alternative.
References
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Dr. Anjani Kumar Singh
Assistant Professor, Department of Orthopaedics, Sarswathi Institute of medical sciences, Hapur, Uttar Pradesh, India.