Arthroscopic Trillat Procedure: A Guided Technique

Abstract

The Trillat procedure is a surgical treatment for recurrent anterior shoulder instability in the setting of significant or irreparable rotator cuff tears in elderly patients. The procedure comprises an inferior closing wedge partial osteotomy of the coracoid process with fixation to the glenoid neck. This results in a lowered and medialized coracoid process that acts as a bone block and the conjoint tendon is brought closer to the glenohumeral joint, thus closing the subcoracoid space, which blocks humeral dislocation. We describe an arthroscopic step-by-step guided Trillat technique that is simple, efficient, and reproducible, while minimizing risk in the extra-articular subcoracoid space. Our technique does not require the release of the pectoralis minor tendon from the coracoid process, which reduces the risk of damaging the brachial plexus. We use a tight-rope fixation construct that allows progressive transfer of the coracoid process, limiting fracture risk and the risk of overtightening of the subscapularis muscle. Because there is a trend for more complex procedures being performed arthroscopically, it is important to develop and simplify operative techniques, aiding surgeons in achieving reproducible and reliable patient outcomes.

Arthroscopic Trillat technique for chronic post-traumatic anterior shoulder instability: outcomes at 2 years of follow-up

“…Only 12 of the operations (23%) lasted more than 60 minutes, with 25 cases (48%) requiring less than 45 minutes. The other authors 16,53,56 who developed a more recent arthroscopic Trillat procedure where partial osteotomy is performed entirely under arthroscopy also report that this procedure is technically less demanding than the arthroscopic Latarjet. Boileau 13 described the arthroscopic Latarjet as technically difficult and potentially dangerous.…”

Open Trillat Procedure for Recurrent Anterior Instability of the Shoulder in Elderly Patients

“…Like for almost all the shoulder stabilization procedure, current works on that surgery are nowadays concerning the arthroscopic technique of the Trillat procedure. 18 As the arthroscopic Latarjet procedure, the arthroscopic Trillat procedure is technically demanding, especially since it is necessary to be extremely careful during the realization of the osteoclasia in order not to break the inferior cortical of the elbow of the coracoid process. If good results are obtained with the arthroscopic technique, it remains challenging and less invasive than the open technique.…”

The Trillat Procedure for Anterior Glenohumeral Instability

“…A suspensory button system is adjusted by a suture tensioner and enables coracoid fixation to the glenoid neck. Soft-tissue Bankart capsular-labral repair with suture anchors might be performed in selected cases of extensive damage 19 .…”

“…Older patients with chronic AGI and massive irreparable posterosuperior RCT 6,[18][19][20]22 * Glenoid or humeral bone lesions [18][19][20] Young patients with AGI and hyperlaxity [18][19][20] Pseudoparalytic shoulder 19 Capsular distension or deficiency 20 Subscapularis lesion 19 ISIS score ,3 with no evidence of plastic capsular insufficiency 20 Rotator cuff arthropathy l $hamada anterior shoulder instability and irreparable RCT. Nineteen shoulders were treated with the Trillat procedure.…”

“…As a result, it is crucial to simultaneously address the anterior glenohumeral capsule and ligaments during the bone block procedure 10 . Therefore, the Trillat procedure combined with anterior capsuloplasty seems to be an effective and safe option for treatment in patients with AGI and hyperlaxity, particularly those without any bone defect 18,19,46 .…”