Dynamic Anterior Stabilization of the Shoulder: Onlay Biceps Transfer to the Anterior Glenoid Using the Double Double-Pulley Technique

Clara I de Campos Azevedo; Ana Catarina Ângelo

doi:10.1016/j.eats.2023.02.048

Dynamic Anterior Stabilization of the Shoulder: Onlay Biceps Transfer to the Anterior Glenoid Using the Double Double-Pulley Technique

Arthrosc Tech. 2023 Jun 12;12(7):e1097-e1106. doi: 10.1016/j.eats.2023.02.048. eCollection 2023 Jul.

Authors

Clara I de Campos Azevedo^{1

2}, Ana Catarina Ângelo^{1

2}

Affiliations

¹ Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hospital dos SAMS de Lisboa, Lisbon, Portugal.
² Shoulder and Elbow Unit, Orthopaedic and Musculoskeletal Centre, Cuf Tejo Hospital, Lisbon, Portugal.

Abstract

The treatment of anterior glenohumeral instability includes several surgical options, ranging from soft tissue to bony procedures-open or arthroscopic. In arthroscopic dynamic anterior stabilization (DAS) of the shoulder, the long head of the biceps is transferred to the anterior glenoid through a subscapularis tendon split. The biceps may be fixed either in an inlay or in an onlay position. Inlay DAS theoretically increases anterior glenohumeral stability through 3 different effects: the hammock effect, sling effect, and the tensioning effect. Onlay DAS may additionally increase stability through a labroplasty effect, produced by the onlay positioning of the biceps on the anterior glenoid rim. The current technical note presents tips and tricks, and pearls and pitfalls, to reproducibly perform onlay DAS using all-suture anchors and the double double-pulley technique.