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Revision Procedures to Manage Soft-Tissue Deficiency: The Role of Muscle Transfer and Grafting
Nonsurgical management and arthroscopic or open capsulolabral repair restore full function in most patients with recurrent shoulder instability. Additional or alternative procedures are needed to manage more severe pathology. Humeral and glenoid bone loss may be amenable to bone grafting procedures or muscle and soft-tissue transfer or grafting procedures.In most patients with mild anterior soft-tissue deficiency, coracoid transfer, with its inherent bony and dynamic stabilization properties, is an adequate option for addressing traumatic anteroinferior instability. Some authors advocate primary Latarjet procedures in patients with hyperlaxity and other risk factors for recurrence, even in the absence of substantial glenoid bone loss. In patients with more severe soft-tissue deficiency, including patients with severe multidirectional and inferior instability (many of whom have undergone one or more failed procedures to manage instability), allograft capsular reconstruction and biceps suspension procedures may be indicated. Subscapularis pathology is extremely common in patients with failed open instability procedures. When subscapularis repair is impossible, pectoralis major transfer is a viable option to improve pain and function.