Scapula-to-scapula tethering for the treatment of scapulothoracic abnormal motion: A novel technique and case series

Background Scapulothoracic abnormal motion (STAM) causes disabling scapular dyskinesis. Alternative, lower-risk strategies are needed. This study evaluates outcomes of scapula-to-scapula tethering (STST). Methods This retrospective series included patients undergoing STST between 2016 and 2023. The technique tethers the scapulae in retraction with an Achilles allograft. Inclusion required deltoid strength ≥4/5, intact rotator cuff, failed nonoperative treatment without glenohumeral pathology. Patients were classified as structural or functional STAM, with functional cases subclassified as rigid, dancing, or severe anterior tilt. Outcomes included range of motion (forward elevation (FE), abduction, external and internal rotation), patient-reported outcomes (PROs: visual analog scale [VAS], subjective shoulder value [SSV], American shoulder and elbow surgeons [ASES] score), and complications defined as early (<3 months) or late (>3 months). Results Twenty-seven patients (78% female; mean age 29 years; mean follow-up 29 months) were included: 10 structural, 17 functional (rigid = 5, dancing = 5, anterior tilt = 7). VAS, SSV, and ASES improved significantly. FE and abduction increased; rotation was unchanged. Three late graft failures occurred, two requiring reoperations. Conclusion STST improved pain, function, and range of motion with low morbidity, suggesting it may be a practical alternative to scapulothoracic fusion. However, findings should be interpreted cautiously given the lack of a comparator group and differing follow-up. Severe anterior tilt may increase graft failure and reoperation risk. Level of evidence IV; case series.