2021 AANA/ASES Specialty Session-Panel Cases

Video Transcription

Video Summary

In this expert panel discussion, Dr. Joe Eichinger, Dr. J.T. Tokish, and colleagues explore complex shoulder instability cases, focusing on surgical decision-making between open Bankart, arthroscopic Bankart with remplissage, and Latarjet procedures. They discuss factors guiding the choice, such as patient risk, bone loss, and athletic demands. Arthroscopic Bankart may fail in high-risk athletes like wrestlers, favoring open procedures or Latarjet for durable stability. Remplissage use remains controversial, often reserved for older, lower-risk patients due to complication risks. The panel highlights advances in arthroscopic bone grafting techniques using distal tibia allografts with suture button fixation as a promising less invasive option. They also address challenging posterior instability cases involving posterior bone loss and retroversion, where bone grafting via a posterior deltoid-splitting approach showed positive outcomes despite early arthritis concerns. Overall, the discussion underscores the nuance in treating shoulder instability, balancing surgical risks, patient-specific anatomy, and evolving arthroscopic techniques to optimize long-term function and stability.

Asset Caption

Moderators: April Armstrong, M.D., Stephen A. Parada, M.D.
Provocateur: John M. Tokish, M.D.
Panelists: Matthew T. Provencher, M.D., Michael J. O’Brien, M.D., Marc S. Kowalsky, M.D., Josef K. Eichinger, M.D.

Keywords

shoulder instability

Bankart repair

Latarjet procedure

arthroscopic bone grafting

remplissage controversy

posterior shoulder instability