This document discusses various surgical techniques for treating anterior shoulder instability caused by bone loss of the glenoid and humeral head. It compares open Latarjet procedure to arthroscopic Latarjet, noting that complication rates are similar between the two approaches. The open Latarjet is still considered the gold standard but arthroscopic Latarjet results in less initial pain. Alternative procedures discussed include iliac crest bone grafts, distal tibial allografts, remplissage to fill large Hill-Sachs defects, and resurfacing of the humeral head.

1. BONE LOSS (GLENOID & HUMERAL HEAD)-
ANTERIOR SHOULDER INSTABILITY
Mangament
Sai krishna MLV

2. TREATMENT
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3. WHY NOT ARTHROSCOPIC BANKART
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7. ARTHROSCOPIC BONY BANKART REPAIR
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12. Autograft options
Allograft options
● Coracoid (Latarjet, Bristow) Iliac crest (Eden-
Hybinette).
● Non anatomic.
● Non articular.
● Anatomic alteration.
● Complications.
● Graft size.
● Distal tibia allograft( good availability, custom
size, dense cortico cancellous bone, robust
cartilage).
● Femoral head allograft and Glenoid allograft
(Difficult to harvest, high contamination).
● Fresh composite allografts.
● Harvested with in 24 hours of asystole, stored
fresh in culture media under refrigeration and
to implant within 28 days to maintain viable
chondrocytes.
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13. LATARJET PROCEDURE
.
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14. Subscapularis split
● Preserves the function.
● Improved strength.
● Less atrophy.
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16. ● 45 patients who underwent latarjet between 2005
and 2010.
● All either had an prior unsuccessful bankart or bone
loss of glenoid.
● Complication rate-25%
● Infection(6%)
Superficial infection resolved with debridement
and antibiotics.
● Recurrent instability(8%)
4 patients- graft resorption and loose screws-
iliac crest graft.
● Neurologic injury(10%)
2 musculocutaneous nerves, one radial and 2
axillary nerves. All but 2 completely resolved.
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17. A
● Over all complications in open latarjet is 15%.
● Meticulous surgical technique with good knowledge of anatomy can help avoid most but not post operative arthritis and
osteolysis.
● Open technique is still the gold standard.
● Complications
 Recurrence –1 to 3%( incorrect patient selection, fracture or malposition of coracoid).
 Coracoid nonunion- 1.5 to 9%(single screws, old patients, aggressive rehab).
 Coracoid fracture – 1.5%(over tightening of screws, old patients, excessive decortication).
 Neurogenic injury- 1 to 20%( avoid extensive dissection, careful retractors placement).
 Infection -1.5%.
 Stiffness – due to subscpularis tenotomy and repair use subscapularis splitting and repair CAL to capsule in max ER.
 Osteoarthritis - (pre existing arthritis, graft position).
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18. ● No clear superiority of open versus arthroscopic.
● Patients treated with arthroscopic latarjet had lower pain scores
over the first few days which become equal by one month.
● 1% of arthroscopic procedures were converted to open.
● Similar rate of complications.
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24. Iliac crest- Eden Hybinette procedure
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27. Distal tibial allograft
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29. REMPLISSAGE
● Primary humeral head bone loss or bipolar
with subcritical bone loss
● Off track lesion
● Not in contact athletes or heavy manual
labour
● Arthroscopic transfer of infraspinatus tendon
which turns the intra articular defect into an
extra articular defect
● 47 patients with arthroscopic bankart +
remplissage for large hill sachs/ engaging hill
sachs lesion.
● Post op imaging demonstrated >75% of defect
filled in 74% patients.
● 98% stable shoulders.
● 8 degrees ER loss at 0 adduction and 9
degrees at 90 abduction.
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31. Resurfacing- Hill sachs
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