Combined All-arthroscopic Hill-Sachs Remplissage, Latarjet, and Bankart Repair in Patients With Bipolar Glenohumeral Bone Loss

Saliken, David; Lavoué, Vincent; Trojani, Christophe; Gonzalez, Jean-François; Boileau, Pascal

doi:10.1016/j.eats.2017.08.001

Cited by 16 publications

(9 citation statements)

References 26 publications

(23 reference statements)

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“…If there is a large and deep Hill-Sachs lesion (based on Calandra grading), 13 engaging over the anterior glenoid neck, a capsulotenodesis of the infraspinatus (remplissage) is performed first. 7,41 The inferior tip of the coracoid, when present, is left in situ if possible to preserve the ''sling effect'' function of the conjoint tendon healed within the subscapularis muscle. 20,50 The glenoid neck is prepared to a flat cancellous surface using a motorized power rasp (Smith & Nephew).…”

Section: Surgical Techniquementioning

confidence: 99%

All-arthroscopic, guided Eden-Hybbinette procedure using suture-button fixation for revision of failed Latarjet

Boileau

Duysens

Saliken

et al. 2019

Journal of Shoulder and Elbow Surgery

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Purpose: To report the results of a guided arthroscopic Eden-Hybbinette procedure, using suture button for iliac crest bone graft fixation, in a series of patients with a prior failed Latarjet and persistent glenoid bone loss. Methods: Seven consecutive patients (5 males, 2 females, mean age: 30.7 years [range, 17-47 years]) with recurrent anterior dislocations and glenoid deficiency greater than 20% underwent the all-arthroscopic revision procedure. The iliac crest bone graft and suture-button device (Bone-Link) were shuttled through the rotator interval. Specific drill guides were used and a suture tensioning device allowed bone graft compression. Previous broken screw shafts (3 patients) were left in situ. Graft placement and healing was assessed postoperatively with computed tomography imaging. Results: No neurologic injury or hardware problems occurred, and no patient required further surgery. On computed tomography scan, optimal positioning (flush and under the equator) and healing of the bone graft was observed in all patients. At a mean follow-up of 21 months (range, 12-39 months), all but one patient were satisfied and had a stable shoulder; 5 returned to sports. The Constant score increased from 32 to 81 points, and the subjective shoulder value from 31% to 87% (P < .001). The Walch-Duplay and Rowe scores averaged 85.7 (range, 65-100) points and 86.4 (range, 70-100) points, respectively. Conclusion: Recurrence of anterior shoulder instability after a failed Latarjet procedure can be successfully treated by an all-arthroscopic Eden-Hybbinette procedure. Suture-button fixation is reliable and permits optimal positioning and predictable healing of the new bone graft; in addition, it is an appropriate fixation option in the setting of retained broken hardware. This study was performed according to the medical ethical guidelines of Institut Universitaire Locomoteur et du Sport (Approval Ref: Study 2017-05), and a written, informed consent was obtained for all patients. A video of the technique is available upon request to the corresponding author.

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Section: Surgical Techniquementioning

confidence: 99%

All-arthroscopic, guided Eden-Hybbinette procedure using suture-button fixation for revision of failed Latarjet

Boileau

Duysens

Saliken

et al. 2019

Journal of Shoulder and Elbow Surgery

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“…Recently described open and arthroscopic techniques to add a remplissage to the Latarjet procedure could be valid alternatives in this situation. 9,19,21 There are several limitations of this study that should be considered. First, it is a retrospective study of prospectively recorded data, and only patients with a preoperative OFF-HS and a complete set of preoperative images and minimum 12-month follow-up CT scan were collected; thus, 17 patients were excluded, raising the possibility of a selection bias.…”

Section: Discussionmentioning

confidence: 98%

Clinical Relevance of Persistent Off-Track Hill-Sachs Lesion After Arthroscopic Latarjet Procedure

Calvo

Rojas

et al. 2021

Am J Sports Med

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Background: The Latarjet procedure is often used to address off-track Hill-Sachs lesions (OFF-HS) in shoulders with anterior instability. There are concerns as to whether the Latarjet procedure is able to convert all OFF-HS into on-track Hill-Sachs lesions (ON-HS) and whether this limitation could explain the cases of recurrent postoperative instability. Hypothesis: Latarjet surgery converts many preoperative OFF-HS lesions, but not all of them, and there is a difference in the failure rate between shoulders with converted lesions and those with persistent OFF-HS lesions. Study Design: Case series; Level of evidence, 4. Methods: Patients with anterior shoulder instability and an OFF-HS lesion treated with an arthroscopic classic Latarjet procedure between January 2010 and September 2017 were retrospectively evaluated. Patients with moderate or severe shoulder arthrosis, rotator cuff tears, or age older than 50 years were excluded. Glenoid track (GT), HS, HS interval (HSI), and the difference between HSI and GT (ΔHSI-GT) were measured preoperatively. A postoperative computed tomography scan and a clinical evaluation, including the Rowe and Western Ontario Shoulder Instability scores, were performed at a minimum 1- and 2-year follow-up, respectively. Postoperatively, 2 groups of patients were obtained: (1) patients with postoperative persistent OFF-HS; (2) patients with postoperative ON-HS. Clinical and imaging data were compared between the 2 groups. Results: A total of 51 patients (n = 51 shoulders), with a mean age of 29.8 ± 8.4 years (range, 15-50 years), met the inclusion criteria. Six shoulders (11.8%) still showed OFF-HS lesions despite Latarjet surgery. There were no postoperative dislocations, but 3 patients reported subluxations. The subluxation rate was significantly higher in the postoperative persistent OFF-HS group (2 [33%] vs 1 [2.2%]; P = .033). There was a wider preoperative HSI (29.8 ± 2.4 mm vs 22.9 ± 3.5 mm; P < .001) and a larger preoperative ΔHSI-GT (12.2 ± 3.8 mm vs 4.82 ± 3.2 mm; P < .001) in the persistent OFF-HS group. A receiver operating characteristic curve was performed based on preoperative ΔHSI-GT values. A preoperative ΔHSI-GT value ≥7.45 mm predicted a persistent OFF-HS after Latarjet surgery (sensitivity, 100%; specificity, 87%; positive predictive value, 50%; and negative predictive value, 100%). Conclusion: Latarjet surgery converted many preoperative OFF-HS lesions into ON-HS lesions, but not all of them. Six patients (11.8%) retained an OFF-HS and had a statistically significantly higher failure rate after Latarjet surgery compared with those with postoperative ON-HS lesions. Because there were few postoperative OFF-HS lesions and few recurrences, findings are statistically fragile and should be confirmed with larger series.

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“…7 Reviewing the literature, Ranne et al first described this technique in 2013, then Katthagen et al in 2016 and Saliken et al in 2017 added the Bankart repair in a 3-in-1 allarthroscopic intervention which is technically demanding, with prolonged intervention duration and potential loss of external rotation. 8,13,14 According to Mook et al, in patients with more than 25% glenoid bone loss, Latarjet alone may lead to an off-track situation and, therefore, instability because the glenoid track length after coracoid graft is inferior to the Hill-Sachs width. 11,12 In these cases, adding remplissage will prevent instability in external rotation.…”

Section: Discussionmentioning

confidence: 99%

Belt and suspender technique for bipolar bone loss in shoulder instability

Abboud

Moussa

Boushnak

et al. 2022

JSES Reviews, Reports, and Techniques

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Combined All-arthroscopic Hill-Sachs Remplissage, Latarjet, and Bankart Repair in Patients With Bipolar Glenohumeral Bone Loss

Cited by 16 publications

References 26 publications

All-arthroscopic, guided Eden-Hybbinette procedure using suture-button fixation for revision of failed Latarjet

All-arthroscopic, guided Eden-Hybbinette procedure using suture-button fixation for revision of failed Latarjet

Clinical Relevance of Persistent Off-Track Hill-Sachs Lesion After Arthroscopic Latarjet Procedure

Belt and suspender technique for bipolar bone loss in shoulder instability

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