AANA24 Shoulder All-Access Pass-GENERAL SCIENTIFIC SESSION: Shoulder Instability (Main Stage)

Video Transcription

Video Summary

The Shoulder Instability session featured expert discussions on arthroscopic Bankart repairs, remplissage procedures, and bone grafting techniques like the arthroscopic Latarjet and distal tibial allograft (DTA) for complex cases. Initial talks emphasized precision in portal placement and careful labrum and bone preparation, highlighting the importance of managing ALPSA lesions and 270-degree labral tears arthroscopically. Remplissage was discussed as an effective adjunct to reduce recurrent anterior instability, supported by biomechanical and clinical evidence demonstrating improved stability and reduced recurrence rates, especially in engaging Hill-Sachs lesions.<br /><br />Attention turned to challenging to diagnose “haggle” and “rargle” capsular tears, underscoring the role of detailed imaging and the utility of mini-open repairs for anterior lesions, while posterior lesions could be managed arthroscopically with careful portal placement and capsular advancement. Arthroscopic Latarjet techniques were presented as complex but effective, offering bone reconstruction with sling effect and soft tissue repair; however, hardware complications like screw loosening were noted and alternatives like suture button fixation have promise with less hardware issues but potential for delayed healing.<br /><br />Debate focused on Latarjet versus DTA, with Latarjet favored for stability and faster return to play, especially in contact athletes, while DTA was promoted for its anatomic cartilage reconstruction and lower rates of graft resorption—important in revision scenarios or large defects. Panelists acknowledged both approaches require high technical skill and attention to indications.<br /><br />Complication discussions stressed the ongoing risks of recurrent instability, graft resorption, arthritis, nerve injury, and challenges with SLAP and posterior capsular tears. Emphasis was placed on the necessity of precise diagnosis, tailored surgical strategies, and effective communication with rehabilitation teams to optimize outcomes. The session concluded with interactive case discussions illustrating decision-making nuances in shoulder instability management.

Asset Caption

Introduction by Moderators: Paul M. Sethi, M.D., Katherine A. Burns, M.D.

Keywords

Shoulder Instability

Arthroscopic Bankart Repair

Remplissage Procedure

Arthroscopic Latarjet

Distal Tibial Allograft (DTA)

ALPSA Lesions

Labral Tears

Hill-Sachs Lesions

Capsular Tears

Bone Grafting Techniques

Postoperative Complications