Anterior Capsulolabral Reconstruction with Semitendinosus Autograft after Latarjet Failure: A Case Report

Abstract

Introduction: The treatment of chronic shoulder instability, associated with poor tissue quality, remains challenging in the setting of anterior capsular deficiency. There are a few viable alternatives in the end-stage shoulder instability when multiple surgical attempts to correct the pathology have failed. The purpose of the present paper is to demonstrate the efficacy of anterior capsular reconstruction with semitendinosus autograft for the management of capsulolabral deficiency without associated bone loss.

Case report: A 39-year-old female admitted in our institution with a history of recurrent atraumatic anterior dislocation of the left shoulder after three unsuccessful surgical attempts: Arthroscopic and open capsulorrhaphy and a Latarjet coracoid transfer. CT scan images showed adequate placement (flush) of the coracoid transfer without any sign of reabsorption. Reconstruction of anterior capsulolabral structure was performed using a Semitendinosus autograft. The middle and inferior glenohumeral ligaments, the more crucial ligaments for anterior-inferior shoulder stability, were effectively recreated. The patient did not suffer any recurrent dislocation or subjective symptoms of instability at the time of the final follow-up, 2 years after surgery, and the ASES score increased from 36 preoperatively to 86.

Conclusion: This technique, described for the first time as a salvage procedure after Latarjet failure, could represent a safe and viable treatment option in the context of multiple ineffective surgeries.

Keywords: Autograft; capsulolabral reconstruction; latarjet; recurrent shoulder instability.

Figure 1

X-ray showing recurrent anterior shoulder dislocation after Latarjet coracoid transfer.

Figure 2

Pre-operative CT scan image demonstrate adequate placement (flush) of the coracoid transfer with no signs of reabsorption.

Figure 3

Semitendinosus autograft positioned along the anterior glenoid rim [Green dotted line]. Four suture anchors (Bio-SutureTak; Arthrex, Naples, FL) inserted with sutures ready to be tied [Blue dotted line].

Figure 4

Semitendinosus autograft is positioned along the anterior glenoid rim and fixed with four suture anchors (bioabsorbable 3.0mm Bio-SutureTak; Arthrex, Naples, FL). The two free ends of the autograft are fixed on the humeral side using two (SwiveLock 4.75mm - Arthrex Naples, FL). The MGHL and IGHL are effectively recreated.

Figure 5

Intraoperative view with simitendinosus autograft in place. (A) Humeral head. (B) Tendon graft reconstructing anterior glenoid labrum. (C) Tendon graft fixed superiorly with SwiveLock anchor (Arthrex, Naples, FL) reconstructing MGHL. (D) Tendon graft fixed inferiorly with SwiveLock anchor (Arthrex, Naples, FL) reconstructing IGHL.

Figure 6

Clinical examination 2 years after surgery.