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Arthroscopic Stablization Cherry Blossom Final 2009

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Arthroscopic Stabilization in Anterior Instability Indications, Pearls and Pitfalls Benjamin Shaffer MD
[object Object],[object Object],In 2009…
[object Object],[object Object],[object Object],[object Object],Improved outcomes likely due to:
[object Object],[object Object],[object Object],[object Object],[object Object],“ Ideal” Arthroscopic Indication 2009
Contraindications 2009
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Contraindications 2009
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Contraindications 2009
[object Object],Contraindications 2009 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Contraindications
[object Object],[object Object],Contraindications 2009 ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Contraindications 2009
[object Object],[object Object],[object Object],[object Object],Contraindications 2009 ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Contraindications 2009
[object Object],[object Object],Significant Glenoid Or Bony Bankart Lesion
Contraindication: Bony Bankart
[object Object],Significant Glenoid Bone Loss
[object Object],[object Object],Significant Glenoid Bone Loss
REC: Preop Bilateral CT’s Significant Glenoid Bone Loss
Bone Loss With Inverted Pear ,[object Object],[object Object],[object Object],Inferior
How to assess arthroscopically? Glenoid Bare spot provides consistent reference point to quantify % bone loss of inferior glenoid
[object Object],[object Object],[object Object],[object Object],A B C D Bone loss 12.5mm 25mm 20mm (25-20)/25 x100 = 20% Calculate Bone Loss
[object Object],Significant Glenoid Bone Loss Treatment Options Anatomic Glenoid Reconstruction Salvage Bristow-Laterjet
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Contraindications 2009
[object Object],[object Object],[object Object],Humeral Bone Loss Significant Hill-Sachs Lesion
[object Object],“ Engaging” Hill-Sachs Lesion
[object Object],Humeral Bone Loss Significant Hill-Sachs Lesion
“ Engaging” Hill-Sachs Lesion
[object Object],[object Object],When to Asses Pre-Op? Consider when…
[object Object],[object Object],How to Asses Pre-Op
[object Object],[object Object],[object Object],How to Asses Pre-Op
[object Object],“ Engaging” Hill-Sachs Lesion ,[object Object],[object Object],[object Object]
[object Object],“ Engaging” Hill-Sachs Lesion ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Humeral Bone Loss Engaging Hill-Sachs Lesion OATS ALLOGRAFT
[object Object],[object Object],[object Object],[object Object],Humeral Bone Loss Engaging Hill-Sachs Lesion
[object Object],Humeral Bone Loss Engaging Hill-Sachs Lesion Clinical Results Pending
[object Object],Humeral Bone Loss Engaging Hill-Sachs Lesion ,[object Object],[object Object],[object Object],[object Object],John Kelly MD Arthroscopy abstract ’07
[object Object],[object Object],[object Object],Humeral Bone Loss Engaging Hill-Sachs Lesion ,[object Object]
Humeral Bone Loss Engaging Hill-Sachs Lesion Auto Body Technique w/ “transhumeral elevation and allograft augmentation of the impacted head fragment”
 
Humeral Bone Loss Engaging Hill-Sachs Lesion Arthroscopic technique limits engagement of defect ,[object Object]
Humeral Bone Loss Engaging Hill-Sachs Lesion
Remplissage ,[object Object],[object Object],[object Object],Results
Salvage Bristow-Latarjet
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Contraindications 2009
[object Object],[object Object],[object Object],[object Object]
[object Object],Another explanation…
[object Object],[object Object],[object Object],Goals of Reconstruction
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Instrumentation 70° 30°
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Surgical Steps
1. Position Patient/EUA
[object Object],[object Object],[object Object],[object Object],2. Establish Portals
2. Establish Portals
3. Evaluate/Tx Pathology
4. Prepare Tissues
5. Insert Anchors
6. Pass Sutures
7. Secure Fixation
Complete the Repair
[object Object],[object Object],[object Object],[object Object],Glenoid IGHL 6 8. Address Capsular Patholaxity/Rotator Interval
[object Object],[object Object],[object Object],[object Object],[object Object],Rotator Interval
[object Object],[object Object],[object Object],Post-op Rehabilitation
Arthroscopic Bankart Results Year Author(s) # Shoulders Mean F/U (months) Recurrence Rate Comments 2005 Mazzocca 18 37 11% Contact/collision 2005 Sugaya 42 34 5% All w/ bony lesions 2005 Bottoni 32 32 3% Prospective 2006 Carierra 72 46 10% Prospective 2006 Marquardt 54 3.7 yrs 7.5% Prospective 2006 Larrain 121 5.9 yrs 8.3% Rugby players 2006 Rhee 16 >2 yrs 25% Collision 2006 Cho 14 >2 yrs 29% Collision 2007 Thal 72 Min 2yr 6.9% 13.5% <22yrs, 7.5% in contact/collision sports 2008 Ozbaydar 93 47 10.7% 7% Bankart vs 19% ALPSA
Arthroscopic Bankart Results Year Author(s) # Shoulders Mean F/U (months) Recurrence Rate Comments 2005 Mazzocca 18 37 11% Contact/collision 2005 Sugaya 42 34 5% All w/ bony lesions 2005 Bottoni 32 32 3% Prospective 2006 Carierra 72 46 10% Prospective 2006 Marquardt 54 3.7 yrs 7.5% Prospective 2006 Larrain 121 5.9 yrs 8.3% Rugby players 2006 Rhee 16 >2 yrs 25% Collision 2006 Cho 14 >2 yrs 29% Collision 2007 Thal 72 Min 2yr 6.9% 13.5% <22yrs, 7.5% in contact/collision sports 2008 Ozbaydar 93 47 10.7% 7% Bankart vs 19% ALPSA
Arthroscopic Bankart Results Year Author(s) # Shoulders Mean F/U (months) Recurrence Rate Comments 2005 Mazzocca 18 37 11% Contact/collision 2005 Sugaya 42 34 5% All w/ bony lesions 2005 Bottoni 32 32 3% Prospective 2006 Carierra 72 46 10% Prospective 2006 Marquardt 54 3.7 yrs 7.5% Prospective 2006 Larrain 121 5.9 yrs 8.3% Rugby players 2006 Rhee 16 >2 yrs 25% Collision 2006 Cho 14 >2 yrs 29% Collision 2007 Thal 72 Min 2yr 6.9% 13.5% <22yrs, 7.5% in contact/collision sports 2008 Ozbaydar 93 47 10.7% 7% Bankart vs 19% ALPSA
Arthroscopic Bankart Results Year Author(s) # Shoulders Mean F/U (months) Recurrence Rate Comments 2005 Mazzocca 18 37 11% Contact/collision 2005 Sugaya 42 34 5% All w/ bony lesions 2005 Bottoni 32 32 3% Prospective 2006 Carierra 72 46 10% Prospective 2006 Marquardt 54 3.7 yrs 7.5% Prospective 2006 Larrain 121 5.9 yrs 8.3% Rugby players 2006 Rhee 16 >2 yrs 25% Collision 2006 Cho 14 >2 yrs 29% Collision 2007 Thal 72 Min 2yr 6.9% 13.5% <22yrs, 7.5% in contact/collision sports 2008 Ozbaydar 93 47 10.7% 7% Bankart vs 19% ALPSA
Caution
[object Object],[object Object],[object Object],[object Object],[object Object],Complications
[object Object],[object Object],[object Object],[object Object],[object Object],Summary
Thank You

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Arthroscopic Stablization Cherry Blossom Final 2009

  • 1. Arthroscopic Stabilization in Anterior Instability Indications, Pearls and Pitfalls Benjamin Shaffer MD
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  • 18. REC: Preop Bilateral CT’s Significant Glenoid Bone Loss
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  • 20. How to assess arthroscopically? Glenoid Bare spot provides consistent reference point to quantify % bone loss of inferior glenoid
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  • 38. Humeral Bone Loss Engaging Hill-Sachs Lesion Auto Body Technique w/ “transhumeral elevation and allograft augmentation of the impacted head fragment”
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  • 41. Humeral Bone Loss Engaging Hill-Sachs Lesion
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  • 62. Arthroscopic Bankart Results Year Author(s) # Shoulders Mean F/U (months) Recurrence Rate Comments 2005 Mazzocca 18 37 11% Contact/collision 2005 Sugaya 42 34 5% All w/ bony lesions 2005 Bottoni 32 32 3% Prospective 2006 Carierra 72 46 10% Prospective 2006 Marquardt 54 3.7 yrs 7.5% Prospective 2006 Larrain 121 5.9 yrs 8.3% Rugby players 2006 Rhee 16 >2 yrs 25% Collision 2006 Cho 14 >2 yrs 29% Collision 2007 Thal 72 Min 2yr 6.9% 13.5% <22yrs, 7.5% in contact/collision sports 2008 Ozbaydar 93 47 10.7% 7% Bankart vs 19% ALPSA
  • 63. Arthroscopic Bankart Results Year Author(s) # Shoulders Mean F/U (months) Recurrence Rate Comments 2005 Mazzocca 18 37 11% Contact/collision 2005 Sugaya 42 34 5% All w/ bony lesions 2005 Bottoni 32 32 3% Prospective 2006 Carierra 72 46 10% Prospective 2006 Marquardt 54 3.7 yrs 7.5% Prospective 2006 Larrain 121 5.9 yrs 8.3% Rugby players 2006 Rhee 16 >2 yrs 25% Collision 2006 Cho 14 >2 yrs 29% Collision 2007 Thal 72 Min 2yr 6.9% 13.5% <22yrs, 7.5% in contact/collision sports 2008 Ozbaydar 93 47 10.7% 7% Bankart vs 19% ALPSA
  • 64. Arthroscopic Bankart Results Year Author(s) # Shoulders Mean F/U (months) Recurrence Rate Comments 2005 Mazzocca 18 37 11% Contact/collision 2005 Sugaya 42 34 5% All w/ bony lesions 2005 Bottoni 32 32 3% Prospective 2006 Carierra 72 46 10% Prospective 2006 Marquardt 54 3.7 yrs 7.5% Prospective 2006 Larrain 121 5.9 yrs 8.3% Rugby players 2006 Rhee 16 >2 yrs 25% Collision 2006 Cho 14 >2 yrs 29% Collision 2007 Thal 72 Min 2yr 6.9% 13.5% <22yrs, 7.5% in contact/collision sports 2008 Ozbaydar 93 47 10.7% 7% Bankart vs 19% ALPSA
  • 65. Arthroscopic Bankart Results Year Author(s) # Shoulders Mean F/U (months) Recurrence Rate Comments 2005 Mazzocca 18 37 11% Contact/collision 2005 Sugaya 42 34 5% All w/ bony lesions 2005 Bottoni 32 32 3% Prospective 2006 Carierra 72 46 10% Prospective 2006 Marquardt 54 3.7 yrs 7.5% Prospective 2006 Larrain 121 5.9 yrs 8.3% Rugby players 2006 Rhee 16 >2 yrs 25% Collision 2006 Cho 14 >2 yrs 29% Collision 2007 Thal 72 Min 2yr 6.9% 13.5% <22yrs, 7.5% in contact/collision sports 2008 Ozbaydar 93 47 10.7% 7% Bankart vs 19% ALPSA
  • 67.
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