Arthroscopic Trillat Coracoid Transfer Procedure Using a Cortical Button for Chronic Anterior Shoulder Instability

Abstract

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.

Arthroscopic Trillat Procedure: A Guided Technique

“…Another advantage of our technique, along with that of Valenti et al 9 , who described an arthroscopic technique with a similar fixation device, is that the use of double-button tension fixation potentially reduces hardware complications 10 and removal. Use of this fixation type may limit coracoid fractures and overtightening of the subscapularis between the glenoid neck and the conjoint tendon.…”

“…Our arthroscopic Trillat technique is simpler and less technically demanding than arthroscopic Latarjet procedures, making it a good initial procedure for surgeons wanting to transition to extra-articular arthroscopic stabilization procedures (Table 3). An important advantage of this technique, compared with other open or arthroscopic Trillat techniques, 8,9 is the lack of release of the pectoralis minor tendon from the coracoid process. This negates the need for dissection medial to the coracoid process and thus reduces the risk of serious intraoperative bleeding and damage to the musculocutaneous and axillary nerves.…”

Arthroscopic Trillat technique for chronic post-traumatic anterior shoulder instability: outcomes at 2 years of follow-up

“…Only 12 of the operations (23%) lasted more than 60 minutes, with 25 cases (48%) requiring less than 45 minutes. The other authors 16,53,56 who developed a more recent arthroscopic Trillat procedure where partial osteotomy is performed entirely under arthroscopy also report that this procedure is technically less demanding than the arthroscopic Latarjet. Boileau 13 described the arthroscopic Latarjet as technically difficult and potentially dangerous.…”

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

“…It allows the assessment of the subscapularis at the end of the procedure to prevent any infra-coracoid impingement (which may lead to a loss of external rotation) as the treatment of associated lesions. 19 …”

“…It allows the assessment of the subscapularis at the end of the procedure to prevent any infra-coracoid impingement (which may lead to a loss of external rotation) as the treatment of associated lesions. 19 Labattut et al 20 described an arthroscopy-assisted Trillat procedure for anterior shoulder instability in 18 patients as a simple and reproductive alternative to arthroscopic Latarjet procedure. They found at a median follow-up of 24.7 months very satisfactory clinical outcomes with 94% of satisfied or very satisfied patients and no recurrences recorded.…”