Arthroscopic transglenoid dynamic subscapular sling achieves short-term clinical outcomes in patients with recurrent shoulder dislocation

PURPOSE: This study evaluated short-term outcomes of arthroscopic transglenoid dynamic subscapular sling (ATDSS) for recurrent anterior shoulder instability (RASI) with < 20% glenoid bone loss (GBL). METHODS: A retrospective series of 25 patients (mean age 36.4 ± 17.3 years) undergoing ATDSS using an adjustable-length loop cortical suspensory fixation device with a tendon graft (semitendinosus autograft, palmaris longus autograft, or tibialis anterior allograft) around the upper subscapularis tendon was analyzed. Outcomes included Oxford Shoulder Instability Score (OSIS), visual analogue scale (VAS), Rowe score, American Shoulder and Elbow Surgeons (ASES) score, recurrence, sports activity, and range of motion at ≥ 12-month follow-up. RESULTS: At mean 20.6 ± 4.9 months, significant improvements were observed: Rowe score (31.2 ± 16.7 vs. 83.0 ± 15.6, P < 0.001; Hedges' g = 3.21), OSIS (33.4 ± 8.0 vs. 20.2 ± 7.9, P < 0.001), ASES (81.6 ± 2.2 vs. 94.3 ± 4.5, P < 0.001), and VAS pain (1.2 ± 0.6 vs. 0.5 ± 0.6, P < 0.001). External rotation decreased (65.6° ± 6.8° vs. 56.5° ± 8.0°, P < 0.001), but only 24% exceeded the 10° minimal clinically important difference. Forward flexion remained unchanged (160.9° ± 15.1° vs. 160.1° ± 14.5°, P = 0.329). Recurrence occurred in 1 patient (4%), with no infections or complications. Sports activity improved (P < 0.001): 48% (12/25) achieved full premorbid activity (Grade I) versus 4% preoperatively. CONCLUSION: ATDSS using an adjustable-loop cortical suspensory device effectively stabilizes RASI with < 20% GBL, yielding low recurrence (4%), significant functional gains (Rowe, ASES, OSIS), and pain reduction. Minor external rotation loss did not impair function. The technique minimizes subscapularis dissection, avoids hardware complications, and preserves anatomy, offering a minimally invasive solution for subcritical GBL. LEVEL OF EVIDENCE: Level IV; Case Series; retrospective study.