Shoulder Instability with Bone Loss: Arthroscopic Treatment Alternative to the Latarjet (AANA19)-Cases_ Shoulder Instability with Bone Loss_ Arthroscopic Treatment Alternative to the Latarjet-Dr. Ivan H. Wong, M.D.

Cases_ Shoulder Instability with Bone Loss_ Arthroscopic Treatment Alternative to the Latarjet-Dr. Ivan H. Wong, M.D.

Video Transcription

Video Summary

The discussion centers on advanced techniques for addressing anterior shoulder instability with bone loss using distal tibial allograft (DTA) for anatomic glenoid reconstruction. Traditional methods like Latarjet and Remplissage have drawbacks: non-anatomic, higher complication rates, subscapularis damage, or limited range of motion. The described arthroscopic DTA technique, performed in lateral decubitus position, preserves the subscapularis, is minimally invasive, and maintains anatomy by reconstructing the glenoid with cartilage-covered distal tibia graft fixed via the novel Halifax portal. This approach allows Bankart repair over the graft, improving joint stability and balance.<br /><br />Early outcomes from a 66-patient series showed no nerve injury, no redislocation, good graft healing, and improved patient scores at two years. Some graft resorption occurred but was physiologic, remodeling grafts toward normal glenoid size. The technique offers faster learning curves and potentially fewer complications than Latarjet. Discussions included graft sizing, anchor placement, and considerations for patients with prior surgeries or arthritis.<br /><br />Case studies highlighted the challenges with revision surgeries after failed Latarjet and Bankart, including subscapularis weakness and arthritis. The panel emphasized individualized treatment balancing grafting, soft tissue repair, and managing patient symptoms. Overall, arthroscopic anatomic glenoid reconstruction with distal tibia allograft is a safe, reproducible alternative showing promising mid-term results in complex shoulder instability with bone loss.

Asset Caption

Instructional Course Lecture: Shoulder Instability with Bone Loss: Arthroscopic Treatment Alternative to the Latarjet

Keywords

anterior shoulder instability

distal tibial allograft

anatomic glenoid reconstruction

arthroscopic DTA technique

Halifax portal

Bankart repair

Latarjet alternative