Arthroscopic Subscapularis Augmentation

The glenohumeral joint is the most commonly dislocated joint of the human body, The stability of GH joint relies on a complex network of static and dynamic structures.

Static stabilizers ::

• include the congruency of the humeral head and glenoid, the glenoid labrum, glenohumeral ligaments surrounding the joint, and negative intra-articular pressure.

Dynamic stabilizers:

are primarily muscular and include the rotator cuff, which provides a compressive stabilizing effect, the tendon of the long head of the biceps, and muscles that stabilize the scapula ,The anterior labrum plays a key role in antero posterior stability as it deepens the glenoid cavity up to 50%.

anterior dislocation is the most common dislocation and is caused by the arm being positioned in an excessive amount of abduction and external rotation.

There are different methods of management

Can be achieved by several surgical techniques, according to whether the underlying etiology is a labral tear (Bankart) , humeral head lesion (Hill- Sachs) , or glenoid bone defect

Traumatic anterior shoulder instability without glenoid bone loss can be successfully treated with Bankart repair . On the other hand, bony procedures such as the Bristow and Latarjet procedures offer better outcomes in cases with concomitant glenoid bone loss greater than 21%-25% and engaging Hill-Sachs lesions

Controversy still exists regarding the ideal surgical treatment for AGI with limited (0%-13.5%) to subcritical (13.5%-25%) glenoid bone loss . Bony procedures are correlated with low recurrence, but high complication rates . On the contrary, clinical studies documented low complication rates [9], but higher recurrence rates or unsatisfactory outcomes for isolated or augmented Bankart repair in the context of subcritical glenoid bone loss

Inclusion criteria

• 1. Patients complaining of anterior glenoid instability , with 1 or more episodes of anterior shoulder dislocation.

• Associated limited (<13.5%) to subcritical (<25%) glenoid bone loss. 3. Positive anterior shoulder apprehension and pain refractory to conservative treatment.

• Age between (15 -49)years old

Exclusion criteria

• 1. Preexisting glenohumeral osteoarthritis, Infection 2. Multidirectional or voluntary shoulder instability. 3.. Acute proximal humerus fractures of the involved shoulder. 4.. refusable of patient