Arthroscopic Remplissage and Open Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Severe Bipolar Bone Loss J. Christoph.

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Arthroscopic Remplissage and Open Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Severe Bipolar Bone Loss J. Christoph Katthagen, M.D., Jack Anavian, M.D., Dimitri S. Tahal, M.Sc., Peter J. Millett, M.D., M.Sc. Arthroscopy Techniques Volume 5, Issue 5, Pages e1135-e1141 (October 2016) DOI: 10.1016/j.eats.2016.06.006 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Anteroposterior and axillary x-rays of left shoulder showing severe Hill-Sachs lesion (HS) of the humeral head and loss of anterior glenoid bone contour (red arrows). Arthroscopy Techniques 2016 5, e1135-e1141DOI: (10.1016/j.eats.2016.06.006) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Axial (A, C) and coronal (B) magnetic resonance imaging planes with measurements for predicted on-track/off-track calculation according to Mook et al.8 The Hill-Sachs interval (HSI, red arrows) measures 40.2 mm (A); the remaining glenoid face measures 19.5 mm (B). The projected glenoid track after Latarjet procedure equals the remaining glenoid face (19.5 mm) plus the maximal width of coracoid (11.9 mm, C) and measures 30.4 mm. The projected glenoid track (30.4 mm) would be smaller than the Hill-Sachs interval (40.2 mm), leaving a persistent off-track situation after Latarjet procedure. Arthroscopy Techniques 2016 5, e1135-e1141DOI: (10.1016/j.eats.2016.06.006) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Microfracture of the Hill-Sachs lesion (HS) with a 30° Power Pick (Arthrex); anterior viewing portal; posterior working portal. (G, glenoid.) Arthroscopy Techniques 2016 5, e1135-e1141DOI: (10.1016/j.eats.2016.06.006) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 (A) Arthroscopy left shoulder, intra-articular view, anterosuperior viewing portal; anchors placed in Hill-Sachs lesion (HS) and sutures passed through the infraspinatus (ISP). (B) Left shoulder, intraoperative view showing the anterosuperior viewing portal with arthroscope (A), the posterior working portal (P) and the additional posterolateral portal with sutures (black arrow). (G, glenoid.) Arthroscopy Techniques 2016 5, e1135-e1141DOI: (10.1016/j.eats.2016.06.006) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Fixation of the transferred coracoid process (white arrows) to the glenoid neck through a deltopectoral skin incision and a subscapularis splitting approach. Arthroscopy Techniques 2016 5, e1135-e1141DOI: (10.1016/j.eats.2016.06.006) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 Conjoint tendon (asterisk) running through the subscapularis split (white dotted line). Arthroscopy Techniques 2016 5, e1135-e1141DOI: (10.1016/j.eats.2016.06.006) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 Completion of the remplissage by tying the infraspinatus (ISP) to the Hill-Sachs lesion. Subacromial space through the anterior viewing portal. Arthroscopy Techniques 2016 5, e1135-e1141DOI: (10.1016/j.eats.2016.06.006) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 Intra-articular view after completion of the remplissage, with Hill-Sachs lesion now effectively being extra-articular (red arrows). Anterior viewing portal. (H, humeral head; ISP, infraspinatus.) Arthroscopy Techniques 2016 5, e1135-e1141DOI: (10.1016/j.eats.2016.06.006) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 9 Postoperative x-rays (anteroposterior, Y, and axillary view) showing the transferred coracoid process fixed with 2 cancellous screws (red arrows). Arthroscopy Techniques 2016 5, e1135-e1141DOI: (10.1016/j.eats.2016.06.006) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions