Anterior Capsulolabral Reconstruction with Semitendinosus Autograft after Latarjet Failure. A Case Report

Introduction: The treatment of chronic shoulder instability, associated with poor tissue quality, remains challenging in the setting of anterior capsular deficiency. There are a few viable alternatives in the end-stage shoulder instability when multiple surgical attempts to correct the pathology have failed. The purpose of the present paper is to demonstrate the efficacy of anterior capsular reconstruction with semitendinosus autograft for the management of capsulolabral deficiency without associated bone loss. Case report: A 39-year-old female admitted in our institution with a history of recurrent atraumatic anterior dislocation of the left shoulder after three unsuccessful surgical attempts: Arthroscopic and open capsulorrhaphy and a Latarjet coracoid transfer. CT scan images showed adequate placement (flush) of the coracoid transfer without any sign of reabsorption. Reconstruction of anterior capsulolabral structure was performed using a Semitendinosus autograft. The middle and inferior glenohumeral ligaments, the more crucial ligaments for anterior-inferior shoulder stability, were effectively recreated. The patient did not suffer any recurrent dislocation or subjective symptoms of instability at the time of the final follow-up, 2 years after surgery, and the ASES score increased from 36 preoperatively to 86. Conclusion: This technique, described for the first time as a salvage procedure after Latarjet failure, could represent a safe and viable treatment option in the context of multiple ineffective surgeries.