Open shoulder stabilization should be based on shared decision-making
KOLOA, Hawaii — When presented with a patient with shoulder instability, orthopedic surgeons should let the literature and shared decision-making be the determinants of when it is best to perform an open stabilization procedure, a speaker at Orthopedics Today Hawaii said.
“Arthroscopic Bankart, I think, is the gold standard at this point. Open Bankart repair is a good option, particularly for patients with [multidirectional instability] MDI, revision and mild bone loss,” Joseph A. Abboud, MD, said.
“If you are going to do an open Bankart with a capsular shift, in my experience, this is for patients who have had a recurrence in instability that has been technically well done. They have hyperlaxity, anterior capsule insufficiency,” he said.
Open coracoid transfer — the Latarjet procedure — is another open shoulder stabilization option to consider, particularly in certain collision athletes. It is often performed in patients with critical bone loss of 15% to 40%, according to Abboud.
“Latarjet is my go-to instability procedure for critical glenoid bone loss. However, there are complications,” he said.
Abboud noted the sling effect the Latarjet achieves with the interior subscapularis and conjoint tendon during abduction/external rotation and its ability to facilitate any needed ligament repairs are among its advantages.
“I really do believe that sling effect is important for added stability from the Latarjet procedure,” he said.
Open procedures must be considered when any type of bone grafting is required, such as with iliac crest bone graft or distal tibial allograft, Abboud said. He said iliac crest bone graft is a nonarticular graft that can be used when a coracoid transfer is not possible or for larger defects, however the technique can predispose the patient to progressive arthritis over time.
“So, in my practice it is rarely used,” Abboud said.
Distal tibial allograft, which is a consideration in young patients with a large amount of bone loss, has promising midterm result rates, he said. “It does give you articular cartilage, fairly robust subchondral bone, but it does have expense to it,” Abboud said.
Open stabilization surgery is associated with a lower recurrence rate and a lower reoperation rate compared with arthroscopic stabilization, in the literature, he said. “Open stabilization lets you do other things,” Abboud said. – by Susan M. Rapp
Abboud JA. Open shoulder stabilization in my practice. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2020; Koloa, Hawaii.
Disclosure: Abboud reports he has stock or stock options with Aevumed; receives research support from Arthrex, Department of Defense, DePuy Synthes, Orthopaedic Research and Education Foundation and Orthospace; receives other financial or material support from Curical Technologies LTD, receives other financial or material support from and has stock or stock options with Dolevium; is a paid consultant for Flexion Therapeutics; has IP royalties from and is a paid consultant for Globus Medical; receives research support from Integra; has IP royalties from Integra Life Science; has stock or stock options with Marlin Medical Alliance LLC; receives other financial or material support from Mininvasive; has stock or stock options with OBERD, Parvizi Surgical Innovation LLC and Shoulder JAM LLC; is a paid presenter or speaker for and receives research support from Tornier; received other financial or material support from Trice Medical; and receives IP royalties and research from and is a paid consultant for Zimmer Biomet.