Dynamic Anterior Stabilization (DAS): Stabilization with the Long Head of the Biceps Tendon
摘要
Dynamic anterior stabilization (DAS) using the long head of the biceps (LHB) tendon is a new arthroscopic technique that fills a treatment algorithm gap between soft-tissue and bony procedures for chronic anteroinferior glenohumeral instability with limited to subcritical glenoid bone loss (GBL) and an engaging Hill-Sachs lesion and/or a superior labrum anterior-posterior (SLAP) type I–III lesion in recreational overhead athletes and throwers and/or in hyperlax patients. DAS may be contraindicated for anteroinferior glenohumeral instability with 25% or more of GBL or a tear of the LHB tendon. The main purpose of the arthroscopic transposition of the LHB tendon through the subscapularis tendon is to dynamically increase the stability of the glenohumeral joint through both a “hammock” and a “sling” effect, with the advantages of a minimally invasive technique that utilizes a soft-tissue in-situ autograft and avoids hardware- and bony transfer-related complications. Different arthroscopic methods of transposing and fixing the LHB tendon to the anteroinferior glenoid rim have been described. The pearls and pitfalls of the all-arthroscopic technical variation of DAS using all-suture anchors and a double double-pulley intra-articular shuttling method to transpose the LHB tendon to the anteroinferior glenoid rim through the subscapularis tendon are presented in this chapter.