Arthroscopically assisted conjoined tendon-coracoid tip complex transfer combined with Bankart repair without screws for traumatic anterior recurrent shoulder instability: clinical and imaging outcomes

TL;DR

A new surgical technique for shoulder instability avoids screws and shows good healing and stability outcomes over time.

Contribution

A screw-free arthroscopic method combining tendon transfer and Bankart repair is proposed for anterior shoulder instability.

Findings

Most coracoid grafts healed completely with the scapular neck.

Only 3.9% of patients experienced traumatic recurrent shoulder instability.

Clinical scores improved significantly without revision surgeries.

Abstract

Screw-related complication rates after the Bristow–Latarjet procedure vary in studies. Hence, we utilized an arthroscopic-assisted conjoined tendon–coracoid tip complex transfer combined with Bankart repair without screws for anterior recurrent shoulder instability.

This retrospective analysis of prospectively collected data included 51 shoulders in 48 patients (39 males, 9 females) who underwent the procedure with a mean age of 24.8 years (range, 15-69 years). Clinical assessments included the American Shoulder and Elbow Surgeons, Constant, Rowe, and Western Ontario Shoulder Instability Index scores. Postoperative complications, including recurrent instability (dislocation, subluxation, or positive apprehension sign), and revision surgeries, were documented. Computed tomography scans were utilized to evaluate postoperative graft healing status.

Clinical scores demonstrated significant improvement from preoperative levels to the final follow-up without revision surgery. Two patients (3.9%) experienced traumatic recurrent shoulder instability (subluxation) at 7 and 9 months postoperatively. At a mean follow-up of 26.7 months (range, 24 to 42), one of these patients reported satisfaction due to the absence of apprehension signs, whereas the other expressed mild satisfaction despite persistent apprehension. Forty-three (84.3%) coracoid grafts achieved complete healing with the scapular neck, whereas 4 (7.8%) exhibited partial healing, 3 (5.9%) showed resorption, and 1 (2.0%) experienced graft migration. Implant migration was not observed.

The index procedure effectively improved shoulder stability and function, achieving a relatively high rate of coracoid graft union with no requirement for revision surgeries at a mean follow-up of 26.7 months.

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