AANA Fellowship Education - Shoulder Instability: Critical Criteria for Surgical Indications-Shoulder Instability: Critical Criteria for Surgical Indications

Video Transcription

Video Summary

This webinar, part of the ANNA Fellowship Education Series, focused on shoulder instability, highlighting surgical indications, techniques, and decision-making. Renowned experts Grant Garagus, Ivan Wong, Stephen Brockmeyer, and Matt Provencher discussed the complexity of treating shoulder instability, emphasizing individualized approaches based on patient factors and bone loss assessment.<br /><br />Ivan Wong introduced the glenoid track concept, a framework for assessing bipolar bone loss—glenoid and humeral head (Hill-Sachs lesion)—and its impact on surgical choices. He explained measuring bone loss via CT scans with 3D reconstructions to determine "on-track" versus "off-track" lesions, guiding the decision between arthroscopic soft tissue repair (Bankart and remplissage procedures) and more complex bone augmentation. He stressed evolving thresholds for critical bone loss (10–13%) influencing surgery.<br /><br />Stephen Brockmeyer reviewed the Latarjet procedure, a primary choice for addressing glenoid bone loss through coracoid transfer, which increases stability via both bony augmentation and a dynamic sling effect from the conjoined tendon. He underscored the importance of patient selection, meticulous surgical technique, and caution regarding potential complications, noting its strong long-term outcomes especially in high-risk patients.<br /><br />Matt Provencher detailed bony reconstruction strategies, comparing options like open Bankart repair, distal tibia allograft (DTA), and Latarjet. He emphasized the significance of addressing bipolar bone loss, labral pathology, and capsular integrity, highlighting that small increments of bone loss substantially affect stability. Provencher supports DTA for osteochondral restoration, noting its cartilage advantage, while acknowledging the Latarjet’s sling effect.<br /><br />The panel engaged case discussions illustrating decision-making complexities, balancing imaging findings, patient activity, and intraoperative assessment. Arthroscopic versus open approaches, the role of remplissage to address Hill-Sachs lesions, and considerations of postoperative function were debated. The session concluded with an emphasis on tailored treatment plans, continuous learning, and the value of fellowship education in advancing shoulder instability care.

Asset Caption

Grant E. Garrigues, M.D. | Stephen F. Brockmeier, M.D. | Matthew T. Provencher, M.D. | Ivan H. Wong, M.D.

Keywords

shoulder instability

surgical indications

glenoid track concept

bipolar bone loss

Hill-Sachs lesion

Latarjet procedure

Bankart repair

distal tibia allograft

arthroscopic soft tissue repair

remplissage procedure