Acromiohumeral Cerclage in Reverse Total Shoulder Arthroplasty for Recurrent Instability. Journal Article

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Authors: Salazar, DH; Bialek, SE; Garbis, NG
Article Title: Acromiohumeral Cerclage in Reverse Total Shoulder Arthroplasty for Recurrent Instability.
Abstract: BACKGROUND: Recurrent shoulder instability after reverse total shoulder arthroplasty (rTSA) presents a challenging clinical problem. A handful of cases have been reported describing stability achieved only after revision rTSA with cerclage augmentation. We describe an acromiohumeral cerclage technique, where the humeral component is fixed with nonabsorbable, high-tensile suture tape looped through transosseous acromial drill tunnels as an augment to salvage shoulder stability. METHODS: All patients treated with acromiohumeral cerclage in rTSA for instability between November 1, 2015 and February 1, 2020, with minimum 1-year follow-up were included. Demographic information, baseline preoperative and postoperative range of motion at most recent follow-up, American Shoulder and Elbow Surgeons (ASES) shoulder scores, and visual analog scale (VAS) scores were recorded and compared. RESULTS: Ten patients, 4 female and 6 male, aged 64.3 ± 7.4 years (range 53 to 77 years) with mean postoperative follow-up of 23-months were included; 90% underwent surgery on the dominant side. Patients underwent an average of 2.1 ± 1.9 prior revisions (range 0 to 7), over an average of 10.4 months (range 0 to 72 months), before revision with suture cerclage augmentation was performed. All patients either had significant past shoulder history at other institutions and/or co-morbidities that added significant complexity to their cases, with an average of 0.6 ± 0.9 (range 0 to 3) prior other shoulder operations performed before their initial rTSA. Average decrease in VAS score among the ten patients was 4.3 ± 2.7 (p 0.05), ranging from 0 to 8 points. Average increase in ASES score was 51.3 ± 21 (p 0.05), ranging from 13.3 to 69.9 points. Average increase in active forward elevation for eight patients was 79° ± 39° (p = 0.0008), ranging from 40° to 160°. All patients have remained stable with well-positioned prostheses since their final operations with no recurrent dislocations or acromial complications. 2 patients unable to travel for an office visit were contacted via phone and answered questions to obtain postoperative ASES and VAS scores. CONCLUSION: Acromiohumeral cerclage suture augmentation in revision rTSA may be a useful, simple surgical strategy to employ with other revision and augmentation techniques to treat cases of recurrent, chronic instability; particularly in the setting of multiple revisions.
Journal Title: JOURNAL OF SHOULDER AND ELBOW SURGERY
Publisher: Unknown  
Date Published: 2022