Anterior Shoulder Stabilization Procedures: From Arthroscopic to Open to Latarjet



Anterior Shoulder Stabilization Procedures: From Arthroscopic to Open to Latarjet


Richard J. McLaughlin, MD

Christopher L. Camp, MD


Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this chapter: Dr. McLaughlin and Dr. Camp.

This chapter is adapted from Bryant B, Bradley JP: Arthroscopic and open Bankart repair, in Flatow E, Colvin AC, eds: Atlas of Essential Orthopaedic Procedures. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2013, pp 7-13.



PATIENT SELECTION




PREOPERATIVE IMAGING

Preoperative radiographs are needed to assess the position of the humeral head with respect to the glenoid, to assess the presence and size of any associated Hill-Sachs or bony glenoid defects, and to rule out any associated fractures, such as those of the greater tuberosity. We routinely obtain true AP, axillary lateral, and scapular Y views. Additional views, such as the apical oblique, West Point, and Didiee, are not routinely obtained but are useful if there is a clinical need to further define bony glenoid defects; the Stryker notch view can better assess Hill-Sachs defects.6,9,10

Given the association of anterior instability to intra-articular pathology, MRI with gadolinium arthrography is routinely performed preoperatively to assess the capsule, labrum, rotator cuff, cartilage, and bony anatomy6 (Figure 1). When significant bone defects are observed on either plain radiographs or magnetic resonance images, a thin-cut, three-dimensional CT scan can be obtained. This modality allows for the subtraction of the humeral head with direct measurement of the glenoid face, in addition to accurate sizing of humeral head defects.3,9 This information is extremely valuable to the clinician as it helps to determine if bony reconstruction of the anterior glenoid is necessary at the time of surgery.5







FIGURE 1 A, Preoperative T2-weighted magnetic resonance arthrograms of the shoulder of a patient with an anteroinferior labral tear, or Bankart lesion (arrow). B, Hills-Sachs lesion (arrowhead).


Feb 2, 2020 | Posted by in ORTHOPEDIC | Comments Off on Anterior Shoulder Stabilization Procedures: From Arthroscopic to Open to Latarjet

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