Scapulothoracic Tenodesis Using Hamstring Tendon Graft for Treatment of Problematic Scapula Winging: A New Surgical Technique

Overview

Journal Shoulder Elbow

Date 2024 May 31

PMID 38818097

Authors

Kishan Gokaraju

Ahmed Mahmoud

Daniel Williams

Phillip Fr Duke

Mark Ross

Affiliations

Soon will be listed here.

Abstract

Introduction: Winging of the scapula occurs due to dysfunction of its stabilising muscles, most commonly serratus anterior and/or trapezius, for example in facioscapulohumeral muscular dystrophy. Resultant loss of scapular control and abnormal kinematics can decrease shoulder function due to glenohumeral joint instability, loss of range of motion and pain. Previously described treatment for cases resistant to physiotherapy includes scapulothoracic arthrodesis which involves risk of non-union and metalwork failure, as well as reduced respiratory function due to immobilisation of a segment of the adjacent chest wall.

Technique: We present a novel surgical approach to the management of problematic scapular winging by using hamstring graft to achieve a scapulothoracic tenodesis.

Discussion: We believe this technique provides an adequately stable scapula for improved shoulder movement and function, a sufficiently mobile chest wall for improved lung function and avoidance of complications specifically associated with arthrodesis.

References

Struyf F, Nijs J, Baeyens J, Mottram S, Meeusen R . Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability. Scand J Med Sci Sports. 2011; 21(3):352-8. DOI: 10.1111/j.1600-0838.2010.01274.x. View

Boileau P, Pison A, Wilson A, van der Meijden O, Sacconi S, Trojani C . Bilateral scapulothoracic arthrodesis for facioscapulohumeral muscular dystrophy: function, fusion, and respiratory consequences. J Shoulder Elbow Surg. 2020; 29(5):931-940. DOI: 10.1016/j.jse.2019.10.006. View

Cooney A, Gill I, Stuart P . The outcome of scapulothoracic arthrodesis using cerclage wires, plates, and allograft for facioscapulohumeral dystrophy. J Shoulder Elbow Surg. 2013; 23(1):e8-13. DOI: 10.1016/j.jse.2013.04.012. View

Thaunat M, Fayard J, Sonnery-Cottet B . Hamstring tendons or bone-patellar tendon-bone graft for anterior cruciate ligament reconstruction?. Orthop Traumatol Surg Res. 2018; 105(1S):S89-S94. DOI: 10.1016/j.otsr.2018.05.014. View

Kord D, Liu E, Horner N, Athwal G, Khan M, Alolabi B . Outcomes of scapulothoracic fusion in facioscapulohumeral muscular dystrophy: A systematic review. Shoulder Elbow. 2020; 12(2):75-90. PMC: 7153204. DOI: 10.1177/1758573219866195. View

Sewell M, Higgs D, Al-Hadithy N, Falworth M, Bayley I, Lambert S . The outcome of scapulothoracic fusion for painful winging of the scapula in dystrophic and non-dystrophic conditions. J Bone Joint Surg Br. 2012; 94(9):1253-9. DOI: 10.1302/0301-620X.94B9.29402. View

Martin R, Fish D . Scapular winging: anatomical review, diagnosis, and treatments. Curr Rev Musculoskelet Med. 2009; 1(1):1-11. PMC: 2684151. DOI: 10.1007/s12178-007-9000-5. View

Kim D, Rhim R, Li L, Martha J, Swaim B, Banco R . Prospective study of iliac crest bone graft harvest site pain and morbidity. Spine J. 2009; 9(11):886-92. DOI: 10.1016/j.spinee.2009.05.006. View

Lanternier H, de Cussac J, Collet T . Short medial approach harvesting of hamstring tendons. Orthop Traumatol Surg Res. 2016; 102(2):269-72. DOI: 10.1016/j.otsr.2015.12.004. View

10.

Andrews C, Taylor T, Patterson V . Scapulothoracic arthrodesis for patients with facioscapulohumeral muscular dystrophy. Neuromuscul Disord. 1999; 8(8):580-4. DOI: 10.1016/s0960-8966(98)00081-9. View

11.

Demirhan M, Uysal O, Atalar A, Kilicoglu O, Serdaroglu P . Scapulothoracic arthrodesis in facioscapulohumeral dystrophy with multifilament cable. Clin Orthop Relat Res. 2009; 467(8):2090-7. PMC: 2706357. DOI: 10.1007/s11999-009-0815-9. View

12.

Stubgen J, Stipp A . Facioscapulohumeral muscular dystrophy: a prospective study of weakness and functional impairment. J Neurol. 2010; 257(9):1457-64. DOI: 10.1007/s00415-010-5544-1. View

13.

Adabag A, Wassif H, Rice K, Mithani S, Johnson D, Bonawitz-Conlin J . Preoperative pulmonary function and mortality after cardiac surgery. Am Heart J. 2010; 159(4):691-7. DOI: 10.1016/j.ahj.2009.12.039. View

14.

Costa Mendes L, Sauvigne T, Guiol J . [Morbidity of autologous bone harvesting in implantology: Literature review from 1990 to 2015]. Rev Stomatol Chir Maxillofac Chir Orale. 2016; 117(6):388-402. DOI: 10.1016/j.revsto.2016.09.003. View

15.

Krishnan S, Hawkins R, Michelotti J, Litchfield R, Willis R, Kim Y . Scapulothoracic arthrodesis: indications, technique, and results. Clin Orthop Relat Res. 2005; (435):126-33. View

16.

Goel D, Romanowski J, Shi L, Warner J . Scapulothoracic fusion: outcomes and complications. J Shoulder Elbow Surg. 2013; 23(4):542-7. DOI: 10.1016/j.jse.2013.08.009. View

17.

Twyman R, Harper G, Edgar M . Thoracoscapular fusion in facioscapulohumeral dystrophy: clinical review of a new surgical method. J Shoulder Elbow Surg. 1996; 5(3):201-5. DOI: 10.1016/s1058-2746(05)80006-0. View

18.

Atasoy E, Majd M . Scapulothoracic stabilisation for winging of the scapula using strips of autogenous fascia lata. J Bone Joint Surg Br. 2000; 82(6):813-7. DOI: 10.1302/0301-620x.82b6.10187. View

19.

Pauzenberger L, Syre S, Schurz M . "Ligamentization" in hamstring tendon grafts after anterior cruciate ligament reconstruction: a systematic review of the literature and a glimpse into the future. Arthroscopy. 2013; 29(10):1712-21. DOI: 10.1016/j.arthro.2013.05.009. View

20.

Eren I, Ersen A, Birsel O, Atalar A, Oflazer P, Demirhan M . Functional Outcomes and Complications Following Scapulothoracic Arthrodesis in Patients with Facioscapulohumeral Dystrophy. J Bone Joint Surg Am. 2019; 102(3):237-244. DOI: 10.2106/JBJS.19.00571. View