No abstract

The arthroscopic Latarjet procedure is challenging because it can be difficult to place 2 screws parallel to the glenoid surface and a medial portal (dangerous for the brachial plexus) is mandatory. In addition, precise positioning of the coracoid bone block flush with the joint line and in a subequatorial position as recommended is troublesome without the use of a guiding system because of the arthroscopic lens distortion. To improve the reproducibility of the arthroscopic Latarjet procedure and to minimize the risk of nerve complications, we developed a guiding system to optimize the positioning of the coracoid bone block and 2 cortical buttons to facilitate its fixation. Four portals are used: a posterior standard portal and 3 anterior portals, all lateral to the conjoint tendon. The anterior rim of the glenoid and the coracoid process are prepared. Two holes are drilled in the glenoid and in the coracoid process with 2 specific guides. The subscapularis is then split, and 2 cortical buttons are passed from posterior to anterior through the tunnels with a shuttle relay. The coracoid process undergoes osteotomy and is guided through the split in the subscapularis to the anteroinferior rim of the glenoid by pulling on the cortical buttons.

Gleno-humeral arthrolysis by arthroscopy combined with hardware removal after proximal humerus ORIF in one step is safe and beneficial for post-traumatic stiffness of the shoulder. It provides significant pain relief and increase of range of motion and allows to treat associated articular pathology.

The Trillat procedure has been proposed to treat chronic anterior shoulder instability by performing a closing wedge osteotomy of the coracoid process fixed with a coracoscapular screw above the subscapularis. The goal of this osteotomy is to distalize and medialize the coracoid tip to place the conjoint tendon in front of the glenohumeral joint. This in turn distalizes and reinforces the subscapularis in abduction and allows the conjoint tendon to act as a sling and push the humeral head posteriorly. It is commonly accepted to perform this surgery for patients with chronic shoulder anterior instability associated with massive irreparable rotator cuff tear (to preserve and retension the residual subscapularis muscle) or in patients with anterior instability and hyperlaxity. We present a less invasive arthroscopic technique for this procedure. This arthroscopic technique allows assessment and treatment of associated lesions and allows for intraoperative assessment of the subscapularis after the coracoid process is moved to prevent subcoracoid impingement and loss of external rotation.

Treatment study, Level II.