AANA24 Shoulder All-Access Pass-CONCURRENT SCIENTIFIC SESSION 5A: Shoulder Instability Papers

Video Transcription

Video Summary

The session covered advancements and debates in the management of anterior shoulder instability, focusing on patient-specific factors, surgical techniques, and outcomes.<br /><br />Dr. Lin introduced the PIT score, a composite risk assessment tool incorporating age, sport type, joint laxity, lesion location, prior dislocations, and bone loss to guide remplissage decisions. Remplissage reduces recurrence in high-risk patients with on-track lesions but may be unnecessary in low-risk cases.<br /><br />Dr. Akhavan presented a novel dermal allograft augmentation for subcritical glenoid bone loss (5-20%), filling a treatment gap between Bankart repair (high failure with bone loss) and bone block procedures (high complications). The technique showed promising early outcomes, incorporation on MRI, and low re-dislocation rates, offering an alternative to more invasive surgeries.<br /><br />Dr. Rashid discussed arthroscopic distal tibial allograft with suture button fixation, demonstrating good graft healing and remodeling in patients with substantial bone loss, with minimal complications over two years. The all-arthroscopic approach offers anatomic reconstruction with fewer complications compared to traditional Latarjet, though longer-term data are pending.<br /><br />Dr. Charles analyzed prognostic factors for recurrence post-Bankart repair, finding contact sports, young age, hyperlaxity, multiple instability events, and bone loss increase failure risk. Adding remplissage benefits higher-risk patients by reducing recurrence and revision surgeries, emphasizing personalized treatment.<br /><br />Dr. Fox compared MRI with MR arthrogram for labral tear extent after dislocation, showing conventional MRI is accurate within two weeks post-injury due to joint effusion contrast; beyond two weeks, MR arthrogram is superior.<br /><br />Dr. Mitsui introduced a dynamic anterior glenohumeral capsule ligament tensioning (DHGT) technique during Bankart repair for overhead athletes, improving shoulder function and external rotation while maintaining stability.<br /><br />The debate centered on managing a 19-year-old gymnast with multidirectional instability (MDI), prior surgeries, and mild bone loss. Dr. Edwards advocated arthroscopic pancapsular plication prioritizing tissue preservation and minimal invasiveness, reserving Latarjet for salvage. Dr. Bützel highlighted challenges of MDI, advocated cautious Latarjet use, favored conservative management, and considered biceps tenodesis-based dynamic stabilization. Dr. Lynch presented a 270-degree capsular plication technique with promising outcomes.<br /><br />Overall, the session highlighted the importance of individualized risk assessment and surgical decision-making, innovations addressing subcritical bone loss, and evolving approaches balancing preservation and stability in complex shoulder instability cases.

Asset Caption

Moderators: Justin W. Arner, M.D., Jamie L. Lynch, M.D.

Keywords

anterior shoulder instability

PIT score

remplissage

dermal allograft augmentation

Bankart repair

arthroscopic distal tibial allograft

suture button fixation

MRI vs MR arthrogram

dynamic anterior glenohumeral capsule tensioning

multidirectional instability (MDI)