AANA/SOMOS Enduring Shoulder Program 2024-21 y.o. Special Operator with Failed Bankart at 8 Months with On-Track Pathology:

Video Transcription

Video Summary

Mark Edelman introduces a case of a 21-year-old special operator with failed arthroscopic Bankart repair and imminent deployment. Dr. Larry Field advocates for revision Bankart repair with remplissage rather than defaulting to Latarjet, citing literature showing better outcomes, fewer complications, and lower recurrent instability rates with remplissage augmentation compared to Latarjet, which carries significant risks. He emphasizes that remplissage, a technique tightening the shoulder by filling Hill-Sachs lesions, should be liberally used in both initial and revision surgeries to improve stability.<br /><br />Dr. O counters by acknowledging challenges in Bankart repairs, particularly underestimating bone loss, and supports Latarjet when appropriate, explaining diagnostic pitfalls, surgical techniques, and patient factors that influence failure. He highlights the complexity of assessing bone loss extent and lesion tracking, advocating for individualized treatment plans based on anatomy, activity level, and specific risk factors. Both discuss imaging needs, technical nuances, and rehabilitation.<br /><br />Cassandra Lee then presents a detailed surgical technique for open Latarjet, including coracoid preparation and graft fixation, underscoring operative steps and technical tips.<br /><br />The panel concludes that remplissage is an essential, underutilized tool that reduces failure rates without added stiffness. Thoughtful patient selection and surgical precision remain key, with no one-size-fits-all solution for failed Bankart lesions and recurrent shoulder instability.

Asset Caption

Open or Revision Arthroscopic Bankart (Larry D. Field, M.D., FAANA) vs. Latarjet (Luke S. Oh, M.D.)
Discussion, moderated by Mark H. Getelman, M.D., FAANA
Technique Video: Latarjet (Cassandra A. Lee, M.D.)

Keywords

Bankart repair

remplissage

Latarjet procedure

shoulder instability

Hill-Sachs lesion

bone loss assessment

revision shoulder surgery