AANA/SOMOS Enduring Shoulder Program 2024-19 y.o. Cadet Lacrosse Player with Multiple Dislocations and Off -Track Instability Pathology

19 y.o. Cadet Lacrosse Player with Multiple Dislocations and Off -Track Instability Pathology

Video Transcription

Video Summary

Drs. Andrew Sheehan and Mark discuss surgical options for shoulder instability with glenoid bone loss, focusing on the Latarjet procedure and free bone block grafting. Sheehan emphasizes the Latarjet’s "sling effect," crucial for stabilization, noting it remains the gold standard despite complex technique and limited high-level evidence favoring alternatives. He cautions skepticism amid emerging arthroscopic glenoid reconstructions due to their difficulty and complication risks. Mark favors arthroscopic anatomic glenoid reconstruction with distal tibia allografts combined with Bankart repair and remplissage, highlighting its lower complication rates, preservation of anatomy, and suitability even for complex cases like seizure patients prone to dislocations. He details a preferred port approach (Halifax portal) for graft placement and discusses graft resorption and cost considerations, preferring frozen allografts for affordability and clinical outcomes. Both advocate tailoring surgery to patient-specific pathology and soft tissue quality, stressing that reconstructive choice evolves with advancing techniques and long-term data.

Asset Caption

Latarjet (Andrew J. Sheean, M.D.) vs. Free Bone Block (Mark H. Getelman, M.D., FAANA)
Discussion, moderated by Felix (Buddy) H. Savoie III, M.D.
Technique Video: Arthroscopically Assisted Glenoid Reconstruction (Richard K.N. Ryu, M.D.)

Keywords

shoulder instability

glenoid bone loss

Latarjet procedure

free bone block grafting

arthroscopic glenoid reconstruction

distal tibia allograft