Dynamic Anterior Shoulder Stabilization Using a Long Head of the Biceps Transfer and Bankart Repair Improves Clinical Outcomes in Patients With Subcritical Bone Loss: A Systematic Review.

PURPOSE

To assess the clinical outcomes of dynamic anterior stabilization using a long head of the biceps transfer (DAS-LHB) with Bankart repair for management of anterior shoulder instability with subcritical glenoid bone loss.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a review of the PubMed, Scopus, EMBASE, and Medline databases was performed in March 2025. Studies were limited to those reporting outcomes for patients ≥16 years old with subcritical glenoid bone loss (≤20%) and undergoing primary DAS-LHB with Bankart repair. Articles were assessed for range of motion, patient-reported outcomes, recurrent instability, and reoperation rates. The Methodological Index for Non-Randomized Studies scoring criteria were used for study appraisal. Forest plots were created to visualize mean differences in variables of interest.

RESULTS

Among the 4 studies evaluated, 90 patients with mean ages of 23.4 to 31.9 years were included. Average follow-up and bone loss ranged from 24.0 to 41.8 months and 8.0% to 10.5%, respectively. Rowe scores showed improvements ranging from 54.5 to 74.0 points, with 87.9% to 100% of patients meeting minimal clinically important difference thresholds. Changes in forward flexion and external rotation ranged from 3° to 23° and -2.3° to 8.3°, respectively. Four patients (4.4%) experienced a recurrence of dislocation, of whom 2 underwent successful revision with a Latarjet procedure. Of all patients, 90.1% to 100.0% were able to return to sport at any level, while 60.0% to 78.8% returned to their preinjury level of athletic involvement.

CONCLUSIONS

DAS-LHB in conjunction with Bankart repair preserves motion while showing clinically important functional improvements with low rates of recurrent instability or complication in the short-term postoperative period for patients with symptomatic shoulder instability.

LEVEL OF EVIDENCE

Level IV, systematic review of Level III and IV studies.