8. Contraindications
1. HAGL
2. Poor Quality Capsulolabral Tissue
3. Intra-capsular IGHL rupture
4. Revision Surgery
ďŽ Previous failed
arthroscopic
ďŽ Patient disappointed
and/or hostile âneed to do
the surgery with the
highest success rate
13. Bone Loss With Inverted Pear
ďŽ Failure rate ~ 60%
with arthroscopic
repair
(Lo, Burkhart Arthroscopy 2000) Inferior
ďŽ â stability to ant
transl w/ defect
>21% glenoid width
14. How to assess arthroscopically?
Glenoid Bare spot
provides consistent
reference point to
quantify % bone
loss of inferior
glenoid
15. Calculate Bone Loss
ďŽ Measure Radius
(12.5mm)
ďŽ Estimate Normal
Diameter (25mm)
ďŽ Measure Actual (25-20)/25
B D
Diameter (20mm) x100 = 20%
A C
ďŽ Bone Loss: Bone
loss
16. Significant Glenoid Bone Loss
Treatment Options
>20 â 25% Loss: Bony
(Open) Procedure
Anatomic Salvage
Glenoid Reconstruction Bristow-Laterjet
26. Humeral Bone Loss
Engaging Hill-Sachs Lesion
John Kelly MD
BONE SUBSTITUTE plugs Arthroscopy abstract â07
ďŽ 12 pts
ďŽ arthroscopic grafting of the
engaging humeral head
lesions.
ďŽ No significant intra-operative
complications
ďŽ Clinical results pending
27. Humeral Bone Loss
Engaging Hill-Sachs Lesion
ďŽ Prosthetic (HEMI-CAP)
ďŽ Multiple sizes
ďŽ Limited data
ďŽ OA, ON, focal
chondral defects
28. Humeral Bone Loss
Engaging Hill-Sachs Lesion
Auto Body Technique w/
âtranshumeral elevation and
allograft augmentation of
the impacted head
fragmentâ
29.
30. Humeral Bone Loss
Engaging Hill-Sachs Lesion
ďŽ Remplissage (French: âTo Fillâ)
Arthroscopic technique limits engagement of defect
32. Remplissage
Results
â˘In an unpublished review, only 2 of 24
patients (7%) had recurrent instability
â˘Both recurrences occurred after sig
trauma.
â˘No sig complications or loss of ROM
35. Collision sports (football, hockey)
ďŽ Stability more important than full motion
ďŽ Cosmesis not a concern
ďŽ Can you afford failure in your high level athlete?
56. Complications
ďŽ Recurrent instability
ďŽ Uncommon
ďŽ Loss of Motion
ďŽ Implant-related problems
ďŽ Nerve Injury
57. Summary
ďŽ Most instability surgery can be performed w/
scope.
ďŽ Donât do arthroscopic procedure in pts with
deficient capsule and sig bone defects
ďŽ Consider arthroscopic repair for revision
cases, HAGL lesions and contact/collision
sports athletes.
ďŽ Practice makes perfect
ďŽ Good to excellent results in most cases.