AANA Lab Course 904 - Shoulder Superstars: Everything You Can Do in a Shoulder Through the Scope! (APEx)-Open Latarjet

Pdf Summary

This presentation from Tulane Orthopaedic Surgery, led by Dr. Felix H. Savoie III, focuses on bone transfers to address shoulder instability, particularly in revision surgeries following failed initial treatments. Key points include the evaluation of bone loss using Bernageau view X-rays and CT scans to detect unrecognized bone defects that contribute to failure and recurrence of shoulder instability.<br /><br />The data show significant failure rates in revision arthroscopic reconstructions (19-40%) and Latarjet procedures (15% failure with 25% complication). Factors worsening outcomes are multiple prior surgeries and patient hyperlaxity (Beighton score). Thus, bone restoration surgery is emphasized as having the best stability outcomes in revision cases with bone loss, despite a higher risk of complications.<br /><br />Surgical tips to improve ease and outcomes include: positioning patients in the beach chair position with scapular support, making a more medial skin incision centered over the coracoid, performing an upper subscapularis tenotomy rather than a split for better exposure, and using guide systems with screws and washers for optimal fixation.<br /><br />Various graft options are discussed: coracoid bone grafts (standard, with noted risks of lysis and variable US outcomes), distal clavicle grafts (easy access, articular cartilage present, used in combination with other repairs), iliac crest bone grafts (for large defects, but with donor site morbidity), fresh articular allografts (adding cartilage, requiring specific techniques), and emerging synthetic grafts including 3D-printed biocompatible implants for tailored defect matching.<br /><br />The Tulane technique showed promising results in 24 revision patients, with excellent stability, average surgical time of 64 minutes, and minimal complications.<br /><br />In summary, bone restoration procedures offer the best option for revision shoulder stabilization when bone loss exists. Surgeons should master multiple techniques to tailor interventions to patient-specific anatomy and clinical experience while being mindful of potential risks. The future may lie in synthetic and 3D-printed grafts to further improve outcomes.

Asset Caption

Dr. Felix H. "Buddy" Savoie, III, M.D.

Keywords

shoulder instability

bone transfers

revision surgery

bone loss evaluation

Bernageau view X-rays

Latarjet procedure

bone restoration surgery

graft options

surgical techniques

3D-printed grafts