Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-23  A: AP x-ray shows large Hill-Sachs lesion. B: Axillary x-ray suggests glenoid bone loss.

■ There was an inverted-pear glenoid with an anteriorly subluxed humeral head (Fig. 3-27). ■ Hill-Sachs lesion was seen to engage the anterior gle- noid when the arm was brought into abduction and external rotation (Fig. 3-28). ■ Following arthroscopic SLAP repair, an open Latarjet reconstruction was performed (Fig. 3-29). Pearls, Pitfalls, and Decision-making: ■ Arthroscopy must be performed prior to the open Latarjet reconstruction in order to discover and repair concomitant pathology, in this case, a SLAP lesion. ■ An intact superior labrum contributes to mechani- cal stiffness and thereby enhances the instability repair. Therefore, a SLAP lesion that is discovered in a patient with anterior instability must be repaired. ■ Latarjet reconstruction addresses both the glenoid bone defect and the humeral bone defect (Hill-Sachs lesion) by a combination of lengthening the articu- lar arc of the glenoid plus providing a posteriorly directed force by virtue of the sling effect of the

conjoined tendon. Therefore, no additional surgical procedures (such as remplissage or humeral bone graft) need to be directed toward the Hill-Sachs lesion whenever a Latarjet reconstruction is done.

The Cowboy’s Conundrum: Locked Anterior Dislocation The Surgeon’s Solution: Open Reduction of Glenohumeral Joint and Open Latarjet Reconstruction History: ■ A 32-year-old male who is an oilfield worker. ■ He went out for a few drinks with friends. He says he was “feeling pretty good” when he tripped and fell onto his outstretched left arm. The next morning, he had pain and decreased motion in the left shoulder but he went to work and continued to work for 2 more weeks.

FIGURE 3-24  Left shoulder MRI. A: ALPSA lesion shows capsule healed in a medialized position. B: Type II SLAP lesion.