Abboud Johnny, Moussa Mohamad K, Boushnak Mohammad O, Rahal Mohammad Jawad H, Robial Nicolas
University of Strasbourg, Faculty of Medicine, Strasbourg, France.
Department of Orthopedic Surgery and Traumatology, Hôpitaux Civils de Colmar, Colmar, France.
JSES Rev Rep Tech. 2022 Apr 22;2(3):354-359. doi: 10.1016/j.xrrt.2022.03.004. eCollection 2022 Aug.
Bipolar glenohumeral bone loss is a challenging condition to address in patients with recurrent anterior shoulder instability. In this category of patients, most isolated soft-tissue procedures such as remplissage or infraspinatus capsulotenodesis are associated with high risk of failure and instability recurrence. Even bony procedures such as Latarjet may fail to provide absolute stability, and instability may eventually recur. For a better understanding of the cause of failure in this particular type of patient, we may refer to the glenoid track concept which has been described as a useful tool for surgical planning. In fact, Latarjet procedure alone may leave a place for engagement of the Hill-Sachs defect on the anterior glenoid resulting in an off-track situation and secondary glenohumeral instability. In this technical note, we present the combination of arthroscopic remplissage and an open Latarjet procedure to treat patients with bipolar glenohumeral bone loss with good results at 31-month follow-up. Our aim is to propose these techniques as a possible rescue procedure for highly unstable shoulders combining engaged Hill-Sachs lesion and glenoid bone loss of more than 25%. We believe this technique would be a good option for patients who present other risk factors of recurrence such as past medical history of epilepsy, laxity, and psychiatric illnesses.
双极型盂肱关节骨质流失是复发性前肩不稳患者中一种难以处理的情况。在这类患者中，大多数单纯的软组织手术，如充填术或冈下肌关节囊固定术，失败风险和不稳复发风险都很高。即使是像Latarjet手术这样的骨性手术也可能无法提供绝对的稳定性，不稳最终可能复发。为了更好地理解这类特殊患者的失败原因，我们可以参考关节盂轨迹概念，它已被描述为手术规划的有用工具。事实上，仅Latarjet手术可能会在前关节盂上留出一个让Hill-Sachs缺损嵌入的位置，导致脱轨情况和继发性盂肱关节不稳。在本技术说明中，我们介绍了关节镜下充填术与开放性Latarjet手术相结合的方法，用于治疗双极型盂肱关节骨质流失患者，在31个月的随访中取得了良好效果。我们的目的是将这些技术作为一种可能的挽救手术，用于治疗高度不稳的肩部，这些肩部合并有嵌入性Hill-Sachs损伤和关节盂骨质流失超过25%的情况。我们认为，对于存在其他复发风险因素（如癫痫病史、关节松弛和精神疾病）的患者，这种技术将是一个不错的选择。
