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

Abstract

Among the many different procedures available in the treatment of shoulder instability, the Trillat procedure remains indicated in case of recurrent shoulder instability in elderly patient with an irreparable cuff tear or in case of hyperlaxity. Despite the constantly increasing number of arthroscopic assisted techniques, the open procedure remains a simple, reliable and fast surgical procedure with a shorter learning curve than the arthroscopic techniques. It consists in a partial osteotomy of the anterior cortical of the coracoid process which is then tilted and fixed with a screw into the anterior part of the scapula downwards and medially to obtain a re-centering effect due to the conjoint tendon on the humeral head when rotational movement are applied. This article aims to present a stepwise approach for the open surgical technique.

The Trillat Procedure for Anterior Glenohumeral Instability

“…However, the surgical rationale is determined by persistent pain, instability, and nonsurgical treatment failure. The aim is to avoid recurrence and morbidity associated with a dysfunctional RC 20 . Clinical assessment and preoperative imaging are crucial to determine the extent and retraction of the lesion, fatty infiltration, atrophy, and degenerative articular lesions 10,30 .…”

“…Figs. 6-G and 6-H Anterior opening wedge osteotomy of the elbow of the coracoid process with an osteotome 20 .…”

“…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.…”

“…Then, a 4-mm cannulated cancellous screw is inserted to secure the translated bone to the glenoid neck. No additional capsulolabral surgical gesture is considered, especially when treating older patients 20 .…”

Arthroscopic Trillat procedure combined with capsuloplasty: an effective treatment modality for shoulder instability associated with hyperlaxity

“…In 1954, Albert Trillat [9, 23] described a surgical technique involving a closing wedge coracoid osteoclasy (partial osteotomy) that redirects the coracoid tip in a distal and medial direction in association with an anterior capsule re‐tensioning. In its new position, the conjoint exerts blocking effect on anterior translation of the humeral head when placing the arm in an abduction and external rotation position [4, 17, 22].…”