Comprehensive Review of Shoulder Instability Includes Diagnosis, Nonoperative Management, Bankart, Latarjet, Remplissage, Glenoid Bone-Grafting, Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up

Abstract

The Delphi method is a structured communication technique used to allow a panel of experts to achieve a consensus in a systematic manner. Expert consensus on shoulder instability includes review of diagnosis, nonoperative management, Bankart, Latarjet, remplissage, glenoid bone-grafting, revision surgery, rehabilitation and return to play, and clinical follow-up. Amplified by Editorial Commentary, this is much to study, clinically relevant, and to the ultimate benefit of our patients.

Arthroscopic Sandwich Autografting Technique for Massive Glenoid Bone Defect Using Iliac Crest and Coracoid Process Grafts

“…The treatment of shoulder joint instability has been a popular topic of discussion over the past decade due to its prevalence and social significance. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 More than 300 surgical techniques have been developed to address this issue, including operations on the shoulder joint capsule, ligament creation, muscle grafting, and bone grafting. 1 , 2 , 3 , 4 , 5 , 6 , 7 Arthroscopic Latarjet surgery is an effective treatment for shoulder joint instability.…”

“…Anterior shoulder instability is a prevalent and socially significant pathology, affecting approximately 96% of shoulder girdle and upper-limb injuries. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Studies have shown that patients with shoulder instability are at a high risk of developing post-traumatic osteoarthritis. Even a single dislocation episode can lead to signs of osteoarthritis in 56% of cases over a 25-year observation period.…”

“…Even a single dislocation episode can lead to signs of osteoarthritis in 56% of cases over a 25-year observation period. 3 , 4 , 5 , 6 , 7 , 8 Conservative treatment is usually ineffective, and surgery is the gold standard for stabilizing the shoulder and preventing recurrence of the pathology. The Latarjet procedure and free iliac crest bone grafting are commonly used surgical options for recurrent anterior instability with a glenoid bone defect greater than 15%.…”

“…Studies have shown that the arthroscopic Latarjet procedure provides excellent clinical results. 1 , 2 , 3 , 4 , 5 However, the main limitation of these methods is the significant glenoid defect that cannot be restored by isolated coracoid transposition or a free bone block. To address this, a technique called the "double-block sandwich technique" has been developed, which involves arthroscopic autografting of both the coracoid and free iliac bone grafts fixed to the glenoid with cannulated screws.…”

“…Preoperative planning and surgical technique control are carried out using 3-dimensional printing technology. 2 , 3 , 4 , 5 , 6 , 7 , 8 This Technical Note describes a specific arthroscopic method for autografting massive glenoid bone defect (Video 1).…”