APEX Shoulder Mastering Surgical Techniques for Clinical Success-Shoulder Bone Loss

Video Transcription

Video Summary

The discussion focuses on managing complex shoulder instability cases with significant bone loss and failed surgeries. One case involved a young man with repeated dislocations despite prior Bankart repairs and a failed Laterjet procedure. Imaging revealed anterior glenoid bone loss with problematic hardware, prompting a revision using an arthroscopic distal tibial allograft (DTA) to restore bone. The challenge lay in navigating scar tissue, hardware removal, and careful graft placement, emphasizing familiarity with anatomy and advanced imaging or 3D printing for planning.<br /><br />The faculty debated fixation methods—screws versus suture buttons—with screws favored for rigid fixation, especially for allografts. The importance of subscapularis management (split versus tenotomy) and the risk to neurovascular structures were highlighted.<br /><br />Another case involved a young hockey player with recurrent instability after Bankart repair. Despite modest bone loss and an on-track Hill-Sachs lesion, experts suggested a bony augmentation like Laterjet with remplissage due to the high-risk collision sport and revision setting.<br /><br />Key surgical tips included patient positioning, incision placement for parallel screw trajectory, and meticulous glenoid preparation. Both open and arthroscopic approaches were discussed, with open surgery favored in challenging revisions for better exposure and nerve safety. The overall consensus stressed tailored approaches, careful preoperative planning, and the need for bony procedures in recurrent, high-demand patients.

Asset Caption

Moderator: William Ciccone, M.D.
Panel: Bogdan Matache, M.D., Michael O’Brien, M.D., Brian Waterman, M.D.

Keywords

shoulder instability

bone loss

Bankart repair

Laterjet procedure

arthroscopic distal tibial allograft

glenoid fixation

subscapularis management