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

  • SHOULDER
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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.

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Acknowledgements

Dr. Paul Saunderson, editing the manuscript. Dr. Erland Hermansen, support and encouragement during the study and writing of the article. Dr. Andreas Fagerhaug Dalen, helping with the preparation of the specimen and consequent surgery. This project involves highly qualified orthopaedic surgeons and radiologists from both Aalesund Hospital and Trondheim University Hospital. The surgery and biomechanical testing were performed at the Hannover Medical University in Hannover, Germany, together with our international collaborating partners.

Funding

The study is funded by Aalesund Hospital and the Norwegian University of Science and Technology, Trondheim, (Grant 46055500-29) Norway. Arthrex GmbH has kindly provided an arthroscopy rack, surgical instruments and anchors, but is not otherwise financially involved.

Author information

Authors and Affiliations

  1. Orthopaedic Department, Aalesund Hospital, Aalesund, Norway

    Terje Vagstad, P. J. Klungsøyr & J. A. Klungsøyr

  2. Norwegian University of Science and Technology, Trondheim, Norway

    Terje Vagstad, J. O. Drogset & J. A. Klungsøyr

  3. Head of the Laboratory for Biomechanics and Biomaterials (LBB), Hannover Medical School, Hannover, Germany

    D. Nebel, M. Ferle & C. Hurschler

Authors
  1. Terje Vagstad
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  2. P. J. Klungsøyr
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  3. J. O. Drogset
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  4. D. Nebel
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  5. M. Ferle
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  6. C. Hurschler
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  7. J. A. Klungsøyr
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Contributions

TV, JAK and PJK have taken part equally in performing the surgery and in writing this article. MF has performed the biomechanical robot testing and the statistics, DN has conducted the biomechanical testing. CH, MF and JOD have contributed to writing and editing the manuscript.

Corresponding author

Correspondence to Terje Vagstad.

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Conflict of interest

None found in the COI forms of all authors, except that Drogset is member of the editorial Board of KSSTA and Section Editor of the Scandinavian Journal of Medicine and Science in Sports.

Ethical approval

This study was reviewed by the local ethical committee at the Hannover Medical School (nr. 3005–2016).

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Vagstad, T., Klungsøyr, P.J., Drogset, J.O. et al. The novel arthroscopic subscapular sling procedure grants better stability than an arthroscopic Bankart repair in a cadaveric study. Knee Surg Sports Traumatol Arthrosc 28, 2316–2324 (2020). https://doi.org/10.1007/s00167-019-05737-3

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  • DOI: https://doi.org/10.1007/s00167-019-05737-3

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