Churchill, Ryan Maxwell, Abby

Conjoined Tendon Transfer for Traumatic Anterior Glenohumeral Instability in Patients With Large Bony Defects and Anterior Capsulolabral Deficiency. - 2018

Available online from MWHC library: 1995 - present, Available in print through MWHC library:2004 - 2007

PURPOSE: To report outcomes of a conjoined tendon transfer procedure in a small case series of young active patients of various activity levels with recurrent traumatic anterior shoulder instability. METHODS: A retrospective chart review identified 10 consecutive patients who underwent conjoined tendon transfer (8 open and 2 arthroscopic) for anterior glenohumeral instability from January 2009 through December 2012. The indications were traumatic anterior shoulder instability with 25% or greater anterior glenoid bone loss, engaging Hill-Sachs lesion, or absent anterior-inferior labral tissue with anterior capsular tissue that did not readily hold sutures or a combination of these deficiencies. Patients did not undergo the procedure if they had healthy capsulolabral tissue and small bony defects or if they competed in high-level collision sports or were overhead throwers. The American Shoulder and Elbow Surgeons (ASES) questionnaire and a physical examination were completed preoperatively. Postoperatively, patients answered questions about shoulder stability and completed ASES and Western Ontario Shoulder Index questionnaires. A physical examination was performed postoperatively to assess range of motion. RESULTS: Of 10 patients, 9 were available for follow-up. The mean age was 33.0 years (range, 18-51 years) at the time of surgery. Eight of nine patients underwent a physical examination at 31.3 +/- 10.5 months (range, 24-58 months) postoperatively. There were no revisions or complications except for recurrent instability in 1 patient who underwent the arthroscopic procedure and reported gross deviation from the postoperative protocol. The ASES score improved significantly (62.8 +/- 21.2 at baseline vs 89.2 +/- 11.5 at final follow-up, P = .01). The postoperative Western Ontario Shoulder Index score was 74.5 +/- 19.7. No significant change was found in external rotation in 90degree of abduction (80.6degree +/- 12.9degree at baseline vs 88.4degree +/- 6.1degree at final follow-up, P = .11) or in flexion (145.6degree +/- 14.9degree at baseline vs 153.1degree +/- 16.4degree at final follow-up, P = .19). All patients returned to their previous activity level. CONCLUSIONS: Stability was restored and no significant range-of-motion loss was observed in noncollision athletes who underwent conjoined tendon transfer. Recurrent instability occurred in 1 patient who underwent the arthroscopic procedure. There were no other complications. LEVEL OF EVIDENCE: Level IV, therapeutic case series. Copyright (c) 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.



S0749-8063(17)30685-0 [pii] 10.1016/j.arthro.2017.06.044 [doi]

*Arthroscopy/mt [Methods]
*Joint Instability/su [Surgery]
Middle Aged
Postoperative Period
Range of Motion, Articular
Retrospective Studies
*Shoulder Injuries/su [Surgery]
Shoulder Joint/in [Injuries]
Shoulder Joint/su [Surgery]
*Tendon Transfer/mt [Methods]
Treatment Outcome
Young Adult

MedStar Union Memorial Hospital

Orthopaedic Surgery
Sports Medicine

Journal Article

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