What did we learn from our first arthroscopic Trillat procedures? Results, complications and failures in a series of 100 anterior shoulder stabilizations

Abstract

Objectives: Arthroscopic adaptation of the Trillat procedure has become a part of the armamentarium for anterior shoulder instability. As the first team to have described a surgical technique, we present the results of our first 100 patients. Methods: This is a cohort study on a prospective database, descriptive of patients who had undergone surgery for chronic anterior shoulder instability between March 2011 the date our technique was developed, and October 2019. Patients were clinically and radiologically evaluated preoperatively (standard radiographs, CT scan) and postoperatively (standard radiographs) at 1, 3, 6 and 12 months and by CT scan 6 months postoperatively to evaluate the consolidation of the coracoid fracture and subscapularis muscle trophicity. Functional results were evaluated by Constant, SSV, Walch/Duplay and Rowe scores and recurrences of accidents due to instability and complications were collated. Results: 100 patients, mean follow-up of 25 months (6-96), mean age, 29 years (15-73), 71% sportspeople, mean age at first episode, 20 years (7-59), 20% hyperlaxity. 67% notches, 22% bony Bankart, 15% glenoid wear and 2% rotator cuff tear. The surgical technique was identical, there were 3 operators, average operating time was 50 min (26-145), 70% were ambulatory, there were 13 fractures and no conversion to an open technique. At the last follow-up there were 3 recurrences of luxation and 4 recurrences of subluxation and in 4 cases failure to recover muscle tone was noted. 95% of the sportspersons resumed their activity, 81% at the previous level. One year postoperatively, the Walsh-Duplay score was 88 (40-100) and the Rowe score was 92 (40-100). There were 4 cases of pseudoarthrosis, 3 of which were due to a technical defect, 2 coracoid fractures, 1 case of resolving sepsis and no neurological complications. There was no damage to the subscapularis. 97% of the patients were satisfied or very satisfied. Conclusion: This is the largest available series on the arthroscopic Trillat procedure. The results are identical to those in the preliminary series and as good as those for the reference techniques. Failures and complications were few and often the result of technical errors. The recovery of muscle tone in the limb on which surgery was performed seemed to influence the effectiveness of stabilization.

The Trillat Procedure for Anterior Glenohumeral Instability

“…After surgical treatment, the dislocation arthropathy process cannot be reversed 29,50 . After a 25-year follow-up from the primary dislocation, the progression to moderate or severe arthropathy in patients with recurrent dislocation was 26% even after successful surgery 50 . Older age at surgery is significantly correlated with OA progression after bone block procedures 21,50 .…”

“…AGI is commonly associated with substantial development of OA. After surgical treatment, the dislocation arthropathy process cannot be reversed 29,50 . After a 25-year follow-up from the primary dislocation, the progression to moderate or severe arthropathy in patients with recurrent dislocation was 26% even after successful surgery 50 .…”