Provencher, Matthew T.

Abstract Anterior shoulder instability is a common cause of shoulder pain and dysfunction in young patients and may be associated with concomitant bony and soft tissue pathology. Humeral avulsion of the glenohumeral ligament (HAGL) and rotator cuff tears are often seen in the setting of traumatic anterior shoulder instability events, especially in patients over 40 years of age, and portend poor postoperative outcomes if not addressed appropriately. While arthroscopic repair of rotator cuff tears is standard of care, both arthroscopic and open approaches for HAGL repair have been described and are associated with good clinical outcomes. Open HAGL repair affords the ability to address additional pathologies, including subscapularis tears and biceps tendon tears/SLAP tears with open subpectoral tenodesis, with direct visualization of the tear, while affording protection of the neurovascular structures. In this Technical Note, the authors describe their preferred technique for combined arthroscopic rotator cuff tear and open HAGL repair. Technique Video video See video under supplementary data.

Purpose The purposes of this study were to investigate the differences between open and arthroscopic closure of the rotator interval (RI) on glenohumeral translation and range of motion. We also sought to determine if the addition of either an open or arthroscopic RI closure increases stability of the shoulder. Methods Fourteen fresh‐frozen (10 paired) cadaveric shoulder specimens were mounted in a custom testing apparatus, and glenohumeral translation and rotation were obtained by using an optoelectric tracking system (Optotrak Certus; Northern Digital, Ontario, Canada). Specimens were randomly allocated to either open (n = 7) or arthroscopic (n = 7) plication of the RI. The following were measured first with an intact and vented specimen and subsequently after an RI closure using either open or arthroscopic techniques: (1) range of motion in neutral and 90° abduction; (2) anterior and posterior translation at neutral rotation; (3) anterior translation at 90° abduction with external rotation; and (4) posterior translation at 90° flexion with internal rotation. Results Posterior stability was not improved from the intact state by either open (1.0‐mm change) or arthroscopic (0.1‐mm change) repair. The sulcus stability was improved in the open group (5.7 mm to 2.9 mm, P = .028), but not arthroscopically (5.1 to 4.1 mm, P = .499). Neutral anterior stability was improved after open repair (7.2 to 2.6 mm, P = .018), but not arthroscopically (2.3 to 2.4 mm, P = 0.5). However, anterior stability in external rotation (ER) at 90° abduction was improved in the arthroscopic repair group (5.5 to 3.1 mm, P = .006). The mean loss of ER in neutral was greater in the open group (40.8°) versus the arthroscopic group (24.4°, P = .0038). The arthroscopic group showed an 11.7° loss of ER in 90° abduction ( P = .018) versus the open group loss of 4.8°. There were no significant differences in loss of IR in either neutral or 90° abduction. Conclusions Posterior stability was not improved by either open or arthroscopic rotator interval repair, and sulcus stability only improved with the open technique. Anterior stability in neutral was improved after open repair and in the arthroscopic repair group with the arm abducted. There was a large loss of external rotation with both techniques. Clinical Relevance This study suggests that arthroscopic RI closure adds little to the overall posterior and inferior stability of the shoulder joint, although anterior stability may be improved. There is a potentially large loss of external rotation after either repair method.