Surgical management of shoulder pathologies has evolved tremendously during the past 3 decades, such that many lesions previously treated with open techniques are now addressed arthroscopically. Despite this movement, many surgeons and outcome studies continue to prefer open repairs as the gold standard, criticizing-with good reason-the reliability, reproducibility, and extended operative time of arthroscopic repairs, particularly with respect to anterior stabilizations and subscapularis repairs. With this in mind, we present the arthroscopic "subdeltoid approach," a novel standardized exposure technique for extracompartmental anterior shoulder arthroscopy. We define the subdeltoid space as the fascial plane bound superiorly by the acromion and coracoacromial ligament, medially by the coracoid and the conjoint tendon, inferiorly by the musculotendinous insertion of the pectoralis major to the humerus, and laterally by the lateral border of the humerus. When coupled with existing arthroscopic tools, this space dramatically enhances our ability to apply open techniques to some of the more challenging anterior shoulder pathoanatomy and expand the indications and efficacy of arthroscopy. This exposure technique has been used in more than 300 cases during the past decade to treat a myriad of shoulder pathologies, without any longstanding postoperative complications.
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[Show abstract][Hide abstract] ABSTRACT: Purpose
The aim of this study was to assess the midterm functional outcomes for arthroscopic subdeltoid transfer of the long head of the biceps tendon (LHBT) to the conjoint tendon.
Fifty-six shoulders in 54 patients (46 men, 8 women; mean age, 42 years) who underwent isolated arthroscopic subdeltoid LHBT transfer to the conjoint tendon by a single surgeon with a minimum of 4 years follow-up were evaluated with American Society of Shoulder and Elbow Surgeons (ASES) and L'Insalata scores. A subset of patients was available for physical examination.
At an average of 6.4 years postoperatively, ASES and L'Insalata scores were 86 and 85, respectively, corresponding to 88% of patients rated good to excellent. Twelve shoulders (10 from men patients, 2 from women patients; mean age 41 years; average follow-up, 6.3 years) underwent physical examination. Mean University of California, Los Angeles (UCLA) score was 31, and there were no significant differences in side-to-side elbow flexion strength or endurance using a 10-pound weight. One patient had a Popeye sign. There were no major complications reported in this cohort.
Arthroscopic transfer of the LHBT to the conjoint tendon is a safe and durable intervention for chronic refractory biceps tendinitis.
Level of Evidence
Level IV, therapeutic case series.
Arthroscopy The Journal of Arthroscopic and Related Surgery 12/2014; 30(12). DOI:10.1016/j.arthro.2014.07.028 · 3.21 Impact Factor