Case-Based, Advanced Decision-Making in Complex Shoulder Instability: Anterior, Posterior, Bone Loss and Revisions (2024 Annual Meeting)-Case-Based, Advanced Decision-Making in Complex Shoulder Instability: Anterior, Posterior, Bone Loss and Revisions

Video Transcription

Video Summary

This session, moderated by Rick Ryu, featured a panel of expert orthopedic surgeons discussing complex shoulder instability cases, focusing on challenging scenarios like posterior instability with dysplastic glenoids, revision anterior instability repairs, and seizure-related bipolar bone lesions.<br /><br />Dr. Steve Parada presented a difficult case of a 16-year-old with recurrent posterior shoulder dislocations after failed posterior labral repair and a markedly retroverted, hypoplastic glenoid. The panel agreed on the need for bony augmentation—preferably using arthroscopic or mini-open distal tibia allograft (DTA) bone blocks—rather than soft tissue repair alone, emphasizing the challenge of reconstructing dysplastic, retroverted glenoids and the risk of early arthritis.<br /><br />A second case described a young athlete with failed arthroscopic Bankart repair and minimal anterior bone loss (~10%). Surgeons debated revision options, with many favoring a Latarjet procedure or combined DTA and remplissage to address both bone loss and soft tissue deficiency. They stressed the importance of technical precision in Bankart repairs and widespread adoption of remplissage to reduce failure rates.<br /><br />Dr. Jean presented a complex seizure-disorder patient with bipolar bony defects including extensive Hill-Sachs and glenoid bone loss after recurrent dislocations. The panel favored a bipolar bony reconstruction using fresh or frozen allografts for both humeral and glenoid defects, accessed via anterior and posterior approaches. They discussed challenges in seizure patients, including timing of surgery, seizure control, and post-op risk, with novel approaches like preoperative muscle Botox injections explored.<br /><br />Throughout, panelists highlighted advanced arthroscopic and open techniques, fixation options (screws vs. buttons), and rehabilitation issues such as addressing scapular dyskinesia and optimal capsular repair configurations. They underscored the need for personalized surgical planning, careful graft shaping, and biomechanical considerations to improve outcomes in complex shoulder instability cases.

Asset Caption

Richard K.N. Ryu, M.D., Moderator | Jeanne C. Patzkowski, M.D. | John M. Tokish, M.D., FAANA | Michael J. O’Brien, M.D., FAANA | Stephen A. Parada, M.D.

Keywords

shoulder instability

posterior instability

dysplastic glenoid

distal tibia allograft

revision anterior instability repair

Latarjet procedure

Bankart repair

remplissage

bipolar bone lesions

seizure-related shoulder dislocation

arthroscopic and open shoulder surgery