Biceps augmentation in dynamic anterior stabilization: A novel on-lay technique for challenging shoulder instabilities

Management of anterior shoulder instability in the presence of subcritical glenoid bone loss or poor anteroinferior capsulolabral tissue quality remains challenging, as isolated soft-tissue repair (e.g. Bankart repair) is often associated with suboptimal outcomes. Dynamic anterior stabilization (DAS) addresses this limitation by transferring the long head of the biceps (LHB) tendon after tenotomy at its articular origin through a subscapularis split and fixing it to the anterior glenoid rim. Although the DAS has shown favorable short-term results, its effectiveness may be reduced in cases with significant capsulolabral deficiency. To address this limitation, we present a modified technique, biceps augmentation DAS. This approach utilizes the intraarticular portion of the LHB tendon to provide additional biological augmentation in patients with subcritical bone loss and capsulolabral insufficiency. This technique combines on-lay fixation at the glenoid equator using knotless anchors with supplementary anteroinferior augmentation using the same anchors placed during Bankart repair.