title: Arthroscopic Subscapularis Augmentation of Bankart Repair in Chronic Anterior Shoulder Instability With Bone Loss Less Than 25% and Capsular Deficiency: Clinical Multicenter Study.
abstract: OBJECTIVE
  To assess the short-term outcomes of the arthroscopic subscapularis augmentation (ASA) technique, consisting of a tenodesis of the upper third of the subscapularis tendon and a Bankart repair, and its effect on shoulder external rotation.
  
  
  METHODS
  Patients selected for this study were involved in contact sports, with a history of traumatic recurrent shoulder dislocations and a minimum of 2-year follow-up. Inclusion criteria were patients with glenoid bone loss (GBL) ranging from 5% to 25%, anterior capsular deficiency, and Hill-Sachs lesion who underwent ASA technique. Exclusion criteria were GBL >25%, multidirectional instability, preexisting osteoarthritis, and overhead sports activities. Visual analog scale (VAS) scale for pain, Rowe score, and American Shoulder and Elbow Surgeons (ASES) scores were used to assess results. Loss of shoulder external rotation was measured with the arm at the side (ER1 position) or 90° in abduction (ER2 position). Analysis of variance and Fisher tests were used for data evaluation. Significance was established at P ≤ .05.
  
  
  RESULTS
  One hundred ten patients (84 men and 26 women, mean age 27 years) were evaluated with a mean follow-up of 40.5 months (range: 24 to 65 months). In 98 patients, a Hill-Sachs lesion was observed and in 57 patients a capsular deficiency was present. Three patients (2.7%) had a traumatic redislocation. At final follow-up, the mean scores were as follows: VAS scale decreased from a mean of 3.5 to 0.5 (P = .015), Rowe score increased from 57.4 to 95.3 (P = .035), and ASES score increased from 66.5 to 96.5 (P = .021). The mean deficit of external rotation was 8° ± 2.5° in the ER1 position and 4° ± 1.5° in the ER2 position.
  
  
  CONCLUSIONS
  The ASA procedure has been shown to be effective in restoring joint stability in patients practicing sports, affected by chronic anterior shoulder instability associated with anterior GBL (<25%), capsular deficiency, and Hill-Sachs lesions, with mild restriction of external rotation.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Sports Medicine Center, San Giovanni-Addolorata Hospital, Rome, Italy. Electronic address: m.maiotti@libero.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Maiotti
authors.affiliation: Sports Medicine Center, San Giovanni-Addolorata Hospital, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Massoni
authors.affiliation: Orthopaedic and Traumatology Unit, Pellegrini Hospital, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Russo
authors.affiliation: BG Trauma Center, Department of Traumatology, Eberhard Karls University, Tübingen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Schroter
authors.affiliation: Arthroscopy Unit, Carlo Poma Hospital, Mantua, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Zanini
authors.affiliation: Isokinetic Group, Rome, Italy.
authors.forename: Diana
authors.initials: D
authors.lastname: Bianchedi
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D056352:Athletes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D012399:Rotation; D017006:Rotator Cuff / Q000601:surgery*; D012540:Scapula / Q000601:surgery; D012720:Severity of Illness Index; D012782:Shoulder / Q000601:surgery*; D012783:Shoulder Dislocation / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery*; D013177:Sports; D053656:Tenodesis; D016896:Treatment Outcome; D055815:Young Adult