2022 Specialty Day Access Pass-Session VII: Shoulder

Video Transcription

Video Summary

The shoulder session, moderated by Gabrielle O'Day and Dr. Kevin Farmer, featured expert discussions focusing on shoulder instability. Dr. Jonathan Dickens emphasized the importance of proper patient selection and surgical technique in arthroscopic Bankart repair, highlighting failure rates, complications, and factors such as timing of surgery, bone loss, and patient activity level. He advocated for modern techniques including strategic anchor placement, mattress sutures, and addressing combined lesions. Dr. Albert Lin elaborated on glenohumeral bone loss, discussing evolving definitions of critical bone loss (now considered between 13.5%-20%), measurement challenges, and the bipolar concept of on-track/off-track lesions. He emphasized cautious management in collision athletes and the potential role of remplissage in near-track lesions.<br /><br />Dr. Ivan Wong presented advancements in arthroscopic bone block procedures using distal tibia grafts through less invasive portals, avoiding subscapularis damage, yielding excellent clinical and radiographic outcomes, with ongoing efforts utilizing augmented reality for surgical training. Dr. Matt Provencher contrasted open Latarjet and distal tibial allograft (DTA) techniques, noting that although the Latarjet remains common, it carries complications and challenges in revision cases, while DTA offers an anatomic reconstruction with promising healing rates.<br /><br />Posterior shoulder instability was addressed by Dr. John Kelly and Dr. Julie Bishop, who underscored the significance of bone loss, glenoid retroversion, and anatomic assessment. They discussed arthroscopic approaches, reverse remplissage, and evolving techniques to manage posterior lesions with less invasive procedures.<br /><br />A multidisciplinary panel discussed management of a young athlete’s recurrent shoulder dislocation, debating early surgery versus non-operative trials and treatment selection based on bone loss and instability patterns. They stressed individualized care, thorough imaging, and functional criteria for return to play.<br /><br />In summary, the session emphasized a nuanced approach to shoulder instability, integrating patient factors, evolving surgical techniques, and bone loss assessment to optimize outcomes.

Asset Caption

Moderators: Kevin W. Farmer, M.D., Gabriella Ode, M.D.

Keywords

shoulder instability

arthroscopic Bankart repair

patient selection

surgical technique

glenohumeral bone loss

remplissage

arthroscopic bone block

distal tibia graft

Latarjet procedure

posterior shoulder instability