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

Authors:

Peter J. Millett, M.D., M.S., J. Christoph Katthagen, M.D., Jack Anavian, M.D., Dimitri S. Tahal, M.S.

Abstract:

Bipolar bone loss in patients with anterior glenohumeral instability is challenging to treat. The goal of the treatment is to restore stability by ensuring that the humeral head remains within the glenoid vault. This can be achieved either with the combination of an arthroscopic Bankart procedure and remplissage (glenoid bone loss <25%), or with a Latarjet procedure (glenoid bone loss >25%). In cases with more severe bipolar bone loss of both the glenoid and the humeral head, the conventional approach has been to lengthen the articular arc of the glenoid and to ignore the Hill-Sachs lesion. However, it has recently been shown that this can still lead to an “off-track” situation with persistent shoulder instability from engagement of the Hill-Sachs on the anterior glenoid. In these cases, the combination of a Hill-Sachs remplissage and the Latarjet procedure can be effective in preventing persistent instability. In this technical note, the surgical technique of an arthroscopic Hill-Sachs remplissage in combination with an open Latarjet procedure is presented.

Severe bipolar bone loss (BBL) in patients with anterior glenohumeral instability (AGI) requires individual treatment strategies depending on the size and location of the bony defects of both the glenoid and the humeral head.1, 2 In such cases with BBL, it is an important factor to define whether the humeral head is on-track or off-track.3, 4, 5 This calculation takes into account the combined bone defects and their locations. In addition, the amount of anterior glenoid bone loss is an essential determinant for the choice of treatment for BBL in AGI. In patients with anterior glenoid deficiency of less than 25%, a combination of an anterior Bankart procedure and posterior remplissage is recommended.6, 7, 8 If the anterior glenoid bone loss exceeds 25% of the anteroposterior expansion, the Latarjet procedure alone is usually indicated.6, 8 In “borderline” cases with distinct BBL of both the glenoid and the humeral head, the combination of a Bankart procedure and a remplissage can severely reduce the capsular volume and restrict the range of glenohumeral motion, especially the range of rotation.7 As Mook et al. have shown, in cases with more severe BBL treated with the Latarjet procedure alone, the humeral head can still be off-track if the Hill-Sachs lesion is not addressed.4 In these cases, the combination of a Hill-Sachs remplissage and the Latarjet procedure should be considered.9 Although conceptually this approach makes sense, performing both procedures together can be technically challenging and has not been described well in the literature. This technical note, therefore, presents the surgical technique of an arthroscopic Hill-Sachs remplissage in combination with an open Latarjet procedure.

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Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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