RESUMEN
Intraoperative vertical coracoid graft fractures during the Latarjet procedure are well-described complications, which typically have a poor prognosis or may necessitate further iliac crest bone grafting for stabilization. The vertical split coracoid fractures are reasoned to be caused by excessive tightening of the screws, poor bone quality, especially in females and the smaller dimension of the coracoid graft. In this technical note, we propose an arthroscopic salvage technique for salvaging the fractured coracoid graft and to avoid the need for additional bone graft, thereby reducing morbidity to the patient. We use two double-loaded, all-suture anchors (Stryker, India) on either side of the split coracoid graft, and double-pulley configuration of suture tightening is done, providing compression and stability to the fractured graft.
RESUMEN
Introduction: We present a case report of an iatrogenic conjoint tendon avulsion fracture following arthroscopic Latarjet and salvage technique to address the complication with a novel double sling technique. Case Report: A 16-year-old male patient who presented with recurrent instability of the right shoulder was counseled for an arthroscopic Latarjet procedure, taking account of critical glenoid bone loss and his contact sporting activities. An intraoperative coracoid tip fracture occurred, which was managed with the double sling technique. At 1-year follow-up, the patient has made a good recovery with a full range of movements and a stable shoulder; the CT scans showed a well-approximated coracoid tip fragment. Conclusion: Iatrogenic intraoperative coracoid graft fractures during arthroscopic Latarjet can be managed depending on the site of the fracture and quality of the bone. The double sling fixation technique helps in maintaining the sling action of the conjoint tendon in patients with recurrent instability.
RESUMEN
Dynamic anterior stabilization using the long head of the biceps tendon is a recently described technique in the management of recurrent shoulder dislocation with subcritical bone loss. This technique involves the transfer of the long head of the biceps to the glenoid, providing sling and hammock effect. The long head of the biceps (LHB) tendon fixation can be accomplished with a variety of implants. We present a modified fixation technique of LHB tendon using transosseous bone tunnel with the adjustable loop length cortical button, incorporating high-strength suture augmentation device in a patient with recurrent glenohumeral instability with limited glenoid bone loss and an engaging Hill-Sachs defect in the humeral head.
RESUMEN
BACKGROUND: Various arthroscopic portals have been described for repair of superior labrum anterior-posterior (SLAP) lesions. The difficulty in doing repair through the rotator interval and the problems in direction and placement of anchors still persist. Functional outcomes of the patients after treating them using trans-cuff portal are well established in literature, but the actual healing of the portal is not clear. We made a sincere effort to identify healing of the trans-cuff portal with ultrasound guidance and functional outcome using American Shoulder and Elbow Surgeons Shoulder Score (ASES score), Constant Shoulder Score, and Oxford Shoulder Score. MATERIAL AND METHODS: Twenty-two patients with SLAP or labral tears and normal contralateral shoulders were included. Surgery was performed using the trans-cuff portal as a viewing or working portal for biceps repair and labral repair. Rehabilitation was initiated from day 1 and followed up on 6 weeks, 3 months and, 6 months with a maximum follow-up duration of 2 years. Ultrasound was used to measure the depth of healing and graded at 6 weeks of follow-up postoperatively. Functional outcomes were measured using ASES score, Constant Shoulder Score, and Oxford Shoulder Score measured at 6 months. RESULTS: Seventeen patients were of grade 1 (complete healing); 1 patient was of grade 2 (more than 50% healing); 1 of grade 3 (less than 50% healing), and 3 were lost to follow-up. Fourteen patients out of 19 had excellent ASES scores, 4 patients had good scores, and 1 patient was considered as poor with an average ASES score of 84.51 (range 93-48) and standard deviation of 10.37. The ASES score indicated that healing of the rotator cuff portal is directly related to the functional outcome of the shoulder. The Constant Shoulder Score and Oxford Shoulder Score on the contrary were statistically not significant indicating no relation of the Oxford and Constant scores with healing of the rotator cuff portals. CONCLUSION: Trans-cuff portal is safe, gives proper angle for insertion of anchors, and can be used for repair of SLAP lesions with ease. Ultrasonography helps in confirming the healing of portal.