The novel arthroscopic subscapular sling procedure grants better stability than an arthroscopic Bankart repair in a cadaveric study.

PURPOSE: This novel arthroscopic subscapular sling procedure stabilizes the shoulder using a semitendinosus graft to create a sling around the subscapular tendon, which provides both static and dynamic stability. The aim of the study was to evaluate the biomechanical stability of the subscapular sling procedure in human cadaveric shoulders. The hypothesis was that the sling offers an equal stabilizing effect and range of motion compared to an arthroscopic Bankart repair. METHODS: Sixteen shoulders were investigated using an industrial robot-based testing platform and four different conditions: the physiologically intact shoulder, after creating a Bankart lesion, after arthroscopic Bankart repair, and finally after applying the subscapular sling procedure using a semitendinosus tendon graft. Joint translation and external rotation were evaluated for each condition. RESULTS: The results show improved stability in the shoulders with the subscapular sling. The robot testing revealed a significant reduction in translation in anterior and anterior-inferior directions compared to the arthroscopic Bankart repair. None of the shoulders were dislocated by forced manual abduction and external rotation. No difficulties were encountered in performing the arthroscopic subscapular sling procedure. Thorough postoperative anatomical dissection showed no alterations to structures at risk. CONCLUSION: The biomechanical results show increased stability with the use of the subscapular sling method.

A new subscapular sling operation to stabilize the shoulder. A cadaver study.

INTRODUCTION: A new arthroscopic shoulder stabilisation procedure is proposed, which for some patients could be an alternative to the arthroscopic Latarjet procedure. METHODS: The objective was to stabilize the shoulder by making a sling around the subscapularis tendon, using a hamstring graft and enhancing the anterior rim of the glenoid with the same graft. The anatomical feasibility of the surgical procedure was tested to establish the surgical method. RESULTS: Four surgeons performed the surgery on six cadavers. After the surgery the cadavers were dissected to visualize the result. The sling was placed according to the intention and the nerves in the area (axillary and musculocutaneus) were not at risk, nor had they altered position during the procedure. CONCLUSION: The procedure is technically feasible and the risk of complications seems low. This procedure could be an alternative to the Latarjet procedure and to other operations used for anterior instability of the shoulder. A biomechanical study will be performed as the next stage of the development. CLINICAL RELEVANCE: This procedure could be an alternative to the Latarjet procedure and to other operations used for anterior instability of the shoulder. TRIAL REGISTRATION: 2012/1978/REK sør-øst.