Anterior Shoulder Ligamentoplasty as a Treatment for Multidirectional Shoulder Instability

Abstract

Multidirectional shoulder instability represents an ongoing challenge for orthopaedic surgeons, and multiple techniques have been described to treat this condition. We present a modified anterior shoulder ligamentoplasty, in which we perform an inferior glenohumeral ligament (IHGL) anteroinferior and posteroinferior plication and, subsequently, an anterior reinforcement ligamentoplasty with an allograft through the subscapularis tendon, with humeral and glenoid fixation. This arthroscopic technique allows shoulder stability in the throwing position, as the humeral head is not uncovered in abduction, and external rotation by ascending the subscapularis tendon.

Fig 1

Anterior shoulder ligamentoplasty as a treatment for multidirectional shoulder instability. Beach chair position, right shoulder.

Fig 2

Patient in the beach chair position; no traction used.

Fig 3

Arthroscopic portals. Viewing portal D. Initial working portal E.

Fig 4

Beach chair position, left shoulder. View portal D. Placement of lower anchors. ANT, anterior anchor; G, glenoid; H, humeral head; POST, posterior anchor.

Fig 5

View from portal E, left shoulder, beach chair position. The space where the humeral tunnel will be made is observed. LD, latissimus dorsi; LHB, long head of the biceps; PM, pectoralis major.

Fig 6

View from portal E, left shoulder. Placement of the guide to perform the humeral tunnel. H, humeral diaphysis; LD, latissimus dorsi; PM, pectoralis major.

Fig 7

View from portal D, left shoulder. Beath pin in position. H, humeral diaphysis; LD, latissimus dorsi.

Fig 8

View from portal D, left shoulder, beach chair position. The guide is placed to drill the glenoid tunnel through portal M medial to the joint tendon. C, coracoid; G, glenoid; SB, subscapularis.

Fig 9

View from portal E, left shoulder, beach chair position. Introduction of the graft into the humeral tunnel. H, humeral diaphysis; PM, pectoralis major.

Fig 10

View from portal D, left shoulder, beach chair position. Introduction of the interference screw into the humeral tunnel through portal M. C, coracoid; G, glenoid; SB, subscapularis.

Fig 11

View from portal D, left shoulder, beach chair position. Graft in transscapular position. C, coracoid; G, glenoid; SB, subscapularis tendon.

Fig 12

View from portal D, left shoulder, beach chair position. Shoulder centred after suturing the lower anchors. ANT, anteroinferior closure; G, glenoid; H, humeral head; POST, posteroinferior closure.